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Musician Uses AAC and Computer Accommodations

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AAC Language-based Model for Assessment and Intervention
AAC Language-based Model for Assessment and Intervention

Jack, a 36-year-old musician, sustained multiple trauma from a motorcycle accident, including open comminuted (shattered) fracture of his larynx, massive destruction to his trachea, tearing of his esophagus and extensive damage to his right arm. He received laryngeal reconstruction immediately after the accident, with further reconstructive surgery planned in six months. Multiple surgeries to his right forearm, wrist and hand also took place in the months after the accident.

Jack's voice is dysphonic, characterized by a hoarse, harsh whisper and low volume, with intermittent episodes of weak phonation. His voice tires during the day and becomes weaker. He has difficulty walking and talking at the same time due to dizziness.

Jack was left hand dominant before the accident, so his writing is not affected. He has non-functional minimal movement in his right fingers and an inability to supinate his right forearm without moving his elbow medially. He uses the right upper extremity primarily as a functional assist, for holding items in position, etc. His arm is constantly cold and he experiences "pins and needles" sensations.

Linda Meyer, a Speech and Language Pathologist (SLP) at Woodrow Wilson Rehabilitation Center (WWRC) performed an augmentative and alternative communication (AAC) evaluation. She conducted an evaluation for technology that would reduce the potential for further damage to his voice from speaking and enable him to communicate clearly and functionally while awaiting surgery to further repair his larynx. There is also the possibility this technology will be needed on a permanent basis after all surgeries are completed.


Over-the-ear microphone
Over-the-ear microphone

1. A voice amplifier was recommended. This is a voice processor, which selectively amplifies certain frequencies of voice, thereby improving the sound of speech, particularly in noisy environments.

2. An over-the-ear microphone was selected due to comfort and sound quality. Jack benefits from the monitor feature on this microphone, which allows him to receive direct feedback of his voice into an earphone. He says that having the direct feedback enables him to monitor his own voice output, therefore he exerts less effort to project his voice.

3. After trying miniature keyboards, Jack found that the lighter key touch of a wireless keyboard, enabled him to activate the keys with decreased effort, which led to greater activity tolerance and reduced fatigue and pain.

4. To enhance direct text input, Jack began using the Macintosh Accessibility feature Sticky Keys, which decreases the number of keystrokes required for multiple keystroke functions (i.e. capitalization).

5. Positioning for computer access and performance were enhanced when Jack was seated according to basic ergonomic principles in an adjustable office chair.

6. Bilateral forearm supports help Jack support his upper extremities and allow him to move and utilize his left upper extremity for information input with increased ease and comfort.

Accommodation List / Sources

Before and After Speech Enhancement
Before and After Speech Enhancement
  • The Speech Enhancer, a voice amplifier, costs approximately $6000. For more information see our product review on page 2 or go to
  • The over the ear microphone was included in the price of the Speech Enhancer
  • The Airkey Wireless Keyboard with Integrated Pointing Device by Acer Peripherals was found at Comp USA Superstore for $50. Acer Peripherals has changed its name to BenQ and can be found at
  • Macintosh Accessibility feature, Sticky Keys, is standard on Macintosh operating system software. A similar feature is built into the Windows operating systems.
  • A Hermann Miller Aeron Highly Adjustable Work Chair costs $739 and can be found at
  • Ergo Rest forearm supports cost $129 and can be found at


This case study was originally documented by Tech Connections, a NIDRR-funded collaboration between United Cerebral Palsy Associations (UCP), the Center for Assistive Technology and Environmental Access at Georgia Tech (CATEA), and the Southeast Disability Business Technical Assistance Center (SE DBTAC).