Fresh Look: Top 5 Switches for People with ALS by Amy Roman

May 7, 2013 by - 1 Comment

Fresh Look: Top 5 Switches for People with ALS by Amy Roman
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We continue our celebration of Better Hearing and Speech Month (#BHSM) with our Fresh Look series. In this post, we are delighted to share the insights of SLP Amy Roman, whose expertise in AAC supports for people with ALS is well-known. Fresh Look: Top 5 Switches for People with ALSDuring the past 13 years, Amy has been a member of the multidisciplinary care team at San Francisco’s Forbes Norris ALS Research and Treatment Center. The AAC Program she developed at the Norris Center was awarded Program of the Year by the California Speech and Hearing Association in 2010. Through her private practice, she also provides AAC direct services and phone/skype consultations to individuals, caregivers and therapists. In addition, Amy is the Director of the Golden West ALS Association’s AAC Lending Library. She is also the author of AlphaCore© communication software available on DynaVox speech generating devices.  Amy has presents workshops and at conferences on clinical and research topics in AAC. Today, she shares her favorite switches for people with ALS and talks about how she utilizes them.

Fresh Look: Top 5 Switches for Use with People who have ALS

What’s a Switch (aka. ability switch)?

A switch is a sensor that can be used by people with very limited movement to turn on/off equipment, click a mouse and interact with a computer or speech generating device.

Three Reasons pALS Need Switches

Switches fly out of our Golden West ALS Association’s AAC Lending Library. Though we have over 20 different switches at our library and demo center, the five listed above are recommended over 90% of the time.

As eye tracking technology has improved, I recommend scanning (an access method that requires use of switches) less frequently but I still have key 3 reasons to regularly recommend switches to pALS.

Activate Call Chime

One essential purpose for a switch is to activate a call chime.  PALS who are non-verbal, have reduced loudness, or are wearing a bi-PAP mask must have a call chime if they are non-ambulatory.  Often they can’t activate a wireless doorbell (found at any hardware store) which is my favorite call chime for people with good manual dexterity.  Many companies including RJ Cooper  and Enabling Devices make adapted call chimes that can be switch activated  by the twitch of a toe, turn of the head or any slight movements a patient may have.  To see how a switch adapted call chime can be set up and used by a pALS with severely limited movement take a look at this video.

Perform a Mouse Click

Switches are also crucial to maintain some people’s abilities to use a mouse.  Often pALS are able to navigate a cursor on the screen but can no longer press a finger to click.  Instead of abandoning the trusty mouse, I often just provide pALS an alternative way to click using a switch.  The trick is knowing how to plug the switch into the computer/SGD/tablet.  Most speech generating devices have built in switch jacks.

Fresh Look: Top 5 Switches for People who use ALS

Computers do not have built in switch jacks so you need a converter like a Swifty that turns a USB port into a 1/8” switch jack.

Fresh Look: Top 5 Switches for People with ALS

If a pALS is using an Android tablet with a mouse then I recommend a switch adapted mouse.  Admittedly, this can create a bit of a drag on the mouse so it isn’t ideal but you are limited to one USB port.  A USB hub will work with some Android tablets so a swifty may be an alternative option.

Fresh Look: Top 5 Switches for People with ALS

Switch adapted mice are availabile at Infogrip or Spectronics.

Turn On/Off  Laser Pointer

Last but not least, I often recommend laser pointers as a means to target words, letters and messages on communication boards.  Laser pointers amplify even slight movements of the head or hand to allow pALS to reach all 4 corners of a communication board.  I prefer switch adapted laser pointer if a pALS has the ability to hit a switch. It’s not a huge surprise that pALS like to be able to turn their laser pointer on/off themselves.  Typically they can at least hit a headrest mounted switch.  This has many advantages.

Fresh Look: Top 5 Switches for People with ALS

Partners know when the pALS has something to say because the laser goes on.  Similarly pALS can indicate when they are done talking by turning off their laser.  Batteries are conserved because pALS turn their laser off when not creating a message.  It also allows pALS with head mounted lasers to look at another person talking without raking that person across the eyes with their laser.  provides adapted laser pointers as well as great videos & instructions for therapists and pALS on how to set up and use laser pointers for communication.

I hope this list of switches and thoughts on  important but less well known ways switches serve the needs of pALS provided ideas and resources useful to SLPs, lending libraries, and of course pALS and their families.

For weekly tips and tools on AAC and other care topics for pALS (e.g. assistive technology, nutrition, OT, PT, psychology, respiratory, etc.) please join me and my team of ALS experts at

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This post was written by Carole Zangari

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