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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.
  1. 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.
  2. 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.
  3. 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


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