Introduction

Among the most disabling impairments in patients with neural injuries are those affecting communication. Fortunately, advances in the technology of communication devices and communication training have greatly expanded the proportion of affected individuals who can reacquire the ability to communicate. Even when residual motor control is very limited, or when there are sensory impairments or parasite movements, technology exists to translate something that the would-be communicator can comfortably do into a means of operating a communication device (e.g., Gragnani, 1990; Gryfe, 1996; Kubota et al., 2000; Perring et al., 2003). Techniques also exist to help most persons with cognitive, language or behavioral challenges to enhance their level of participation and control (Trepagnier, 1996; Gorman et al., 2003). Nor is cost a major barrier, since devices and techniques to support communication are generally affordable, and third-party reimbursement has become increasingly available (Smith, 1998; Higdon, 2002).

Communication devices can make an important difference in the quality of life of people affected by disorders that result in impaired speech or writing (Tolley et al., 1995; Diener and Bischof-Rosarioz, 2004). Youngsters with severe movement disorder from cerebral palsy can pursue educational and career goals (McNaughton and Bryen, 2002). Patients with amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) can continue to communicate with their family, friends and colleagues when they can no longer speak (Doyle and Phillips, 2001).