Proloquo2Go: Assistive communication for the iPhone and iPod touch

Proloquo2Go [iTunes Link] is not your usual iPhone/iPod touch app. It turns the mobile device into a full augmentative and alternative communication (AAC) device. According to the AAC Institute, an estimated 2.5 million Americans are speech disabled to the extent that they experience significant difficulty being understood by other people. Reasons vary, but are often the result of congenital illness or ALS (also known as Lou Gehrig's disease). ~~75% of people using AAC devices have ALS~~.

One alternative is learning how to use sign language, but that requires both adequate sensory motor ability of the user and a knowledge of sign language expected in the listener. It's a solution that helps some, but not all.

When signing is not available or appropriate, using an AAC device may well be. AAC devices use combinations of symbols, words, sounds and technology to allow people without functional vocal abilities to communicate. The cost of such devices range from around US$3,500 to US$8,500 for something about the size of a Speak and Spell.

In contrast, the Proloquo2Go app has a price of US$189.99. If someone is in the market for an AAC system, it is one of the biggest bargains in the entire App Store for any iPhone or iPod touch running OS 2.1 or higher.

Proloquo2Go took the uncommon route of using existing hardware to run a complex AAC system. It's nearly impossible to describe the use of the system through words, though I'll try, but I'd suggest you check out some detailed videos walking you through the process in some depth.
The home screen is a totally configurable grid defaulting to 4X4 (16 boxes) and can be changed to show anywhere from 32 boxes to 1 box depending upon the user's preference and ability. From here you start to construct your phrase, which will be spoken in a very natural sounding voice by a variety of voices, young or mature, male or female, with an American or English accent. The stock version comes with 4 American accented voices while English accented ones may be downloaded. Downloading a voice can take as much as 115 megabytes of space which should give you an idea of how natural the voices sound. The base app itself is 235 megabytes in size.

Through a totally customizable set of intuitive screens, you build a phrase by clicking on a symbol with words under it. You start on the home screen where you choose from categories such as: Hi-Bye, I need, I want, Comments etc. Tapping one gives you underlying words and phrases. Tapping again moves the phrase and symbol to the top bar as you construct your phrase or sentence. From this point you go back and choose another category to find the next word or phase, but more often than not, the system is so well organized that it takes you to where you want to be seemingly by magic. The magic here is extensive research into AAC using common elements and conventions of the field.

Here's an example of putting together the sentence: I want a drink of cranberry juice.

From the home screen choose the I want icon. Tap it and the words I want and a symbol appear on the top phrase bar.
On the I want screen that appears there are choices ranging from: something to eat, to listen to music, a drink, among others. Tap on a drink of and a drink of along with its icon appears after I want on the phrase bar. It also takes you to the a drink page.
The a drink page contains 42 choices with appropriate icons. Tap on Cranberry Juice and those words along with a symbol of a cranberry juice bottle appears on the phrase screen. Double tap on the bar to hear the phrase clearly spoken. Of course, for most uses there would be speakers attached to the iPhone or iPod touch to improve audibility.

I hope you noted that at no point did I go backward. The branching structure in Proloquo2Go naturally links things to one another until you have what you want. You can save your phrase, assigning it either an existing symbol or picking a picture that will be used as the symbol (from your photo library or via the iPhone camera), and slot it into a new or existing category. Now you can save the phrase: I want a drink of cranberry juice, with a button along with a symbol for later use as a one-touch statement.

The depth and organization of the vocabulary is large and quite detailed, and the logic behind the hierarchical branching going from screen to screen is eerily intuitive. Still, I can't imagine it being complex enough for anyone but children to effectively communicate, which makes the amount of user customization critical. This is where Proloquo2Go really shines. You can change the way anything is presented. The grid system can be changed to lists, the number of boxes can vary, background colors can be changed as well as text colors. Proloquo2Go uses the Goosens', Crain and Elder color conventions of pink for verbs, green for prepositions, yellow for nouns and orange for miscellaneous.

More importantly, you can add anything you like to the vocabulary by typing it in on either an overlarge keyboard or a usual keyboard that doesn't do landscape mode. There is a section marked word spaces for this, but you can really add anything to anywhere. I believe the idea is to take what they gave you as a jumping off place and customize it until it perfectly suits the user. It seems that nothing is really set in stone.

That does bring up the potential of really screwing things up, which is solved by having the device communicate with a host computer to frequently back up data. It would have been easy to leave something like that out, but the attention to detail is commendable. The more you play with Proloquo2Go, the more you find, like auto-morphology which allows you to auto conjugate verbs and auto pluralize or personalize nouns. This works not just for their canned vocabulary but for any user created content as well.

At this point one might expect an iPhone developer to scoff a bit and say that this can be programmed in a weekend and sold for US$20 at a huge profit. I disagree, since this is more than the nuts and bolts purport. It's based on a huge amount of research and experience in the AAC field and is quite a bit more than just branching screens and buttons.

To put it in perspective, it brings the field down from the thousands-of-dollars range to the price of a $199 iPod touch plus the app. It can be the center of a full AAC system with speakers for under US$500, opening up AAC to a world of users that couldn't afford to pay for it themselves and couldn't get it covered under Medicaid or Medicare, which covers most AAC devices. This customary medical coverage may well be one of the reason for the high prices these devices currently command.

According to the New York Times and Gizmodo, Medicaid and Medicare will only pay for single-purpose devices, and since the iPhone and iPod touch are multi-purpose they are not included in the coverage. Forcing consumers who want to get their device covered to buy one that's 10-20x more expensive seems foolish. Once again it seems that technology has outstripped law, and I hope that this inexcusable coverage hole will be repaired.

The design and implementation of Proloquo2Go is a great example of thinking outside the box. Instead of a huge price-tag for a uni-purpose device, AssistiveWare decided to use existing hardware and begin changing the game, making AAC more accessible to more people for less money than ever before -- and that's quite an accomplishment.

Take a look at this video for a brief news story involving Proloquo2Go.

Note: TUAW was provided with a review copy of this application. For more information, please see http://www.tuaw.com/policies

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iPhone iPod touch App Review

Proloquo2Go [iTunes Link] is not your usual iPhone/iPod touch app. It turns the mobile device into a full augmentative and alternative...

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Sharon May

I think it's great that these apps are being made available as an alternative to the bulky more expensive devices. The ipod is way cooler than the big heavy device he has now and never uses.

But... as the mother of a son who has aphasia, apraxia, and dysarthria as a result of a head injury and has had the $5000 device for going on 3 years now, more is not always better...the more choices he has to go through to get to what he wants to say the more likely he is to just sign or mime the message he wants to convey.

I just downloaded the free Locabulary app and with a few additions, I think it will do what is needed. At least I will be able to see how much more willing he is to use the ipod and see if it's easier for him to navigate through all the choices before spending another couple hundred $ on a smaller, 'cooler' version of what he already has.

December 07 2009 at 12:26 PM Report abuse Permalink rate up rate down Reply

now4real954

OMG...where do I start...first I have to stop crying...

this article and the comments that followed have touched my heart in a great way...

thank you for doing this article and even more thanks for the developers that made it...

I myself do not have any real experience with the impaired that this app would help...but I do feel the emotion of what it is and can do for people that need it...

my hope is that this will pave the way for those that can't afford such technology to be able to get it

I am Touched, Moved and Inspired by this article and it is something I will remember for a long time...thank you TUAW

October 31 2009 at 6:07 PM Report abuse Permalink rate up rate down Reply

mike

I'm a speech pathologist and have worked with a couple of adults who use the Proloquo2Go device. It's a bit much to say that it straight up competes with $8000 dedicated devices, but compared to other AAC devices it is very affordable. This iPhone is a great device for individuals with communication impairments, not just as an AAC device, but as a therapy tool. I've "repurposed" a few apps for therapy with some of my stroke clients. I think a developer could carve out a nice little niche making therapy apps.

October 21 2009 at 7:49 PM Report abuse Permalink rate up rate down Reply

joey

My daughter (2yr) has NF (Neurofibromatosis) and there are devices out there (like the article pointed out) which are fairly big. My health care will offset most of the cost of these large single purpose devices.

She is pretty proficient on the iPhone that I started to search for an app that we could put pictures and record voices on a few months ago. Proloqui2go came up on my search however, the app as well as the cost of a iPod Touch is not covered under our health care plan.

Further searching the app store i found iConverse. At $9.99 it does the basics of what Prologui2go does. It's a bit more rudimentary but certainly is easier on the wallet.

What would be nice is if the makers of Prologui2go can get with health care providers and make a complete package (app + Touch) that can be covered under health plans. Much like how when we ordered the walker and other learning aids for our daughter.

October 21 2009 at 7:34 PM Report abuse Permalink rate up rate down Reply

1 reply to joey's comment

JKT

My understanding is that Medicare will not pay for any device that might be usable for any other purpose. Because an iPhone can run other apps, they won't pay for Proloquo2Go. I suppose this rule is to prevent Medicare fraud, but in this case it's hurting the end-users.

October 22 2009 at 9:28 AM Report abuse Permalink rate up rate down Reply

Robert

As the parent of a child with Autism I purchased this app as well as iConverse. My 8 year old son now carries his iPod Touch with him all of the time. It is really the ideal device for him, I have some movies and TV shows he loves on it as well. I am very thankful for this software as it has really helped us mitigate his tantrums when he can not "find the right words"

October 21 2009 at 7:29 PM Report abuse Permalink rate up rate down Reply

Samuel Sennott

Thank you very much TUAW for the review and encouragement. You, Gizmodo, and the NY Times have helped bring people with speech disabilities to the forefront of conversation around the world.

As both a PhD student in the field of augmentative and alternative communication, as well as being a co-developer of Proloquo2Go, I have a deep knowledge of the systems that are involved with the people who it is served by, the environments and contexts we are working in, as well as the possibilities for the future.

Regarding price, we straight up compete with $8,000 devices. For the $189.99 we charge, we license a range of technologies including symbols, high quality voices, and grammatical technology. We have stuck our necks out there and placed a flag in the moon so to speak for accessibility on the iPhone and iPod touch. We are so happy to offer a huge value to our users. Yet, know that we provide a ton of support and trainings around the US and the world. I just want to be crystal clear that we do this for the love. We are very committed and very lean, which enables us to keep the cost low.

That being said, there is great risk in throwing together open source special education technology in that people depend on the technology. I know there are huge upsides and I commend the awesome developers who provide free services to the community. It is awesome! Thank you for doing that. Yet, the risk is always that people get hurt by abandoned efforts. Anyway, it is great to engage in these conversations. For all together we will make a difference!

Cheers,

Samuel Sennott

First, know that people's lives are at stake with this technology. There are plenty of hastily created special education apps cropping up. Yet,

October 21 2009 at 3:35 PM Report abuse Permalink rate up rate down Reply

2 replies to Samuel Sennott's comment

SaintStryfe

Aces to you friend.

I never really thought of my iPhone as a Adaptive Device, until I was sitting with it on the table and my three year old niece picked it up, opened the photo app and started looking at the photos in there.

If a three year old could use it, with little prompting and minimal instruction, it's use as an adaptive device is remarkable. I would have to believe that an Apple Tablet, which would be bigger and more capable would be an even greater boon.

I do believe that the insurance industry has given license for Adaptive Tech developers to charge ridiculous prices for things that technology has developed that should be much less. I hope your application is a first strike towards brining this sort of tool to greater numbers of people. Thank you.

October 21 2009 at 4:33 PM Report abuse Permalink rate up rate down Reply

Moose

My girlfriend, who is a speech therapist and loves this app for her clients, also had another fantastic point: a lot of kids that use this device, are just that... kids. Its embarrassing to them to have to lug around a speak and spell sized, expensive device that "outs" them in public. And beyond simply providing them with a highly capable AAC device, they also get a hot MP3/video player, so its something that they *want* to carry around and use. So as a surrogate for the GF, kudos to you guys!

October 22 2009 at 4:51 AM Report abuse Permalink rate up rate down Reply

metalgimpsolid

While Proloquo2Go does cost more than the typical iPhone app, its price is still a fraction of the $2,000 to $8,000 price range that comparable AAC solutions run. As Dirk correctly surmised, the developer must pay a licensing fee for the text-to-speech voices; however, their expenses do not end there, as they must also pay licensing fees for the symbols and grammar technology, and pay a staff to handle tech support and pre-sale inquiries, which is much more than the typical iPhone app and probably more in line with desktop software. When you add that all up, plus Apple's 30% take of App Store sales, the price is easier to understand.

October 21 2009 at 2:56 PM Report abuse Permalink rate up rate down Reply

Dave Boyd

@David Winograd - True, iPrompts is a very different product. But it is another one that is bridging the gap on overly expensive communication aids. It does involve AAC, but is simply targeted for a different audience.

Before this product, people were relegated to using cumbersome flash cards, bulky books, or intrusive devices to help their child communicate.

October 21 2009 at 2:04 PM Report abuse Permalink rate up rate down Reply

1 reply to Dave Boyd's comment

David Winograd

Yes, re-reading the definition of AAC, iPrompt certainly can be categorized as using AAC. I wonder how broad the definition goes.

Proloquo2Go is about the disable person communicating with another.
iPrompt instead seems to deal with organizing tasks for a disabled person and isn't about speech per-se, but it IS about communication.

October 21 2009 at 3:00 PM Report abuse Permalink rate up rate down Reply

Kathy

"75% of people using AAC devices have ALS." I looked at this link source and think you may have drawn the wrong conclusion. The source indicates that 75% of people with ALS use AAC technology.

Proloquo is an amazing piece of software! Thanks for the post.

October 21 2009 at 1:35 PM Report abuse Permalink rate up rate down Reply

1 reply to Kathy's comment

David Winograd

Thanks. I've redacted the line.

October 21 2009 at 7:30 PM Report abuse Permalink rate up rate down Reply

David Winograd

iPrompts looks quite useful but for totally different reason. iPrompts has nothing to do with AAC, it doesn't even use voice. It's reason for being is as a life organizer for cognitively disabled children.

Admirable and from what I can tell from the site, quite useful, but one really has nothing to do with the other.

October 21 2009 at 1:20 PM Report abuse Permalink rate up rate down Reply