Voice banking for people living with motor neurone disease: Views and expectations

How People Living With Amyotrophic Lateral Sclerosis Use Personalized Automatic Speech Recognition Technology to Support Communication

PURPOSE

Amyotrophic lateral sclerosis (ALS) is a progressive, ultimately fatal disease causing progressive muscular weakness. Most people living with ALS (plwALS) experience dysarthria, eventually becoming unable to communicate using natural speech. Many wish to use speech for as long as possible. Personalized automated speech recognition (ASR) model technology, such as Google's Project Relate, is argued to better recognize speech with dysarthria, supporting maintenance of understanding through real-time captioning. The objectives of this study are how plwALS and communication partners use Relate in everyday conversation over a period of up to 12 months and how it may change with any decline in speech over time.

METHOD

This study videoed interactions between three plwALS and communication partners. We assessed ASR caption accuracy and how well they preserved meaning. Conversation analysis was used to identify participants' own organizational practices in the accomplishment of interaction. Thematic analysis was used to understand better the participants' experiences of using ASR captions.

RESULTS

All plwALS reported lower-than-expected ASR accuracy when used in conversation and felt ASR captioning was only useful in certain contexts. All participants liked the concept of live captioning and were hopeful that future improvements to ASR accuracy may support their communication in everyday life.

CONCLUSIONS

Training is needed on best practices for customization and practical use of ASR technology and for the limitations of ASR in conversational settings. Support is needed for those less confident with technology and to reduce misplaced allocation of ownership of captioning errors, risking negative effects on psychological well-being.

The ethical significance of user-control in AI-driven speech-BCIs: a narrative review

AI-driven brain-computed interfaces aimed at restoring speech for individuals living with locked-in-syndrome are paired with ethical implications for user's autonomy, privacy and responsibility. Embedding options for sufficient levels of user-control in speech-BCI design has been proposed to mitigate these ethical challenges. However, how user-control in speech-BCIs is conceptualized and how it relates to these ethical challenges is underdetermined. In this narrative literature review, we aim to clarify and explicate the notion of user-control in speech-BCIs, to better understand in what way user-control could operationalize user's autonomy, privacy and responsibility and explore how such suggestions for increasing user-control can be translated to recommendations for the design or use of speech-BCIs. First, we identified types of user control, including executory control that can protect voluntariness of speech, and guidance control that can contribute to semantic accuracy. Second, we identified potential causes for a loss of user-control, including contributions of predictive language models, a lack of ability for neural control, or signal interference and external control. Such a loss of user control may have implications for semantic accuracy and mental privacy. Third we explored ways to design for user-control. While embedding initiation signals for users may increase executory control, they may conflict with other aims such as speed and continuity of speech. Design mechanisms for guidance control remain largely conceptual, similar trade-offs in design may be expected. We argue that preceding these trade-offs, the overarching aim of speech-BCIs needs to be defined, requiring input from current and potential users. Additionally, conceptual clarification of user-control and other (ethical) concepts in this debate has practical relevance for BCI researchers. For instance, different concepts of inner speech may have distinct ethical implications. Increased clarity of such concepts can improve anticipation of ethical implications of speech-BCIs and may help to steer design decisions.

A recent survey of augmentative and alternative communication use and service delivery experiences of people with amyotrophic lateral sclerosis in the United States

PURPOSE

The objective of this study was to explore and describe current trends in the augmentative and alternative communication (AAC) use and service delivery experiences of people with amyotrophic lateral sclerosis (PALS) in the U.S.

METHODS

Cross-sectional data were collected from 216 PALS via an anonymous online questionnaire in 2021.

RESULTS

Over 70% of participants reported at least some detectable speech disturbance, and approximately half used aided communication during face-to-face interactions. Among respondents with severe speech impairment, over 90% reported using speech-generating devices, and just over half reported using low-tech AAC. Most participants had met with an SLP to discuss speech and communication, but varied in both timing of the initial intervention and frequency of ongoing intervention. Fewer than half reported that their family members or other important people had received education or support related to communication for PALS. Participants also shared their use of and experiences with telephone and video calls, access methods, mounting systems, word prediction and stored phrases, and message and voice banking.

CONCLUSIONS

Results highlight the importance of early referral for AAC intervention, ongoing re-evaluation and treatment, involvement of communication partners and support for multimodal communication and adaptation to changing needs.

Identity-Focused Practice in Augmentative and Alternative Communication Services: A Framework to Support the Intersecting Identities of Individuals With Severe Disabilities

PURPOSE

The purpose of this clinical focus article is to consider a framework of identity in provision of services to individuals with severe disabilities who use augmentative and alternative communication (AAC).

METHOD

Components of the framework for identity include personal, social, and cultural areas. These aspects are identified in extant literature on AAC services and discussed through the lens of the Communication Bill of Rights (National Joint Committee for the Communication Needs of Persons with Severe Disabilities in 1992). Identity-focused practice is discussed as being relevant to self-determination and quality of life among individuals with severe disabilities.

RESULTS

A case study illustrates identity-focused practice in delivery of services to an adolescent who uses AAC, considering personal, social, and cultural identities.

CONCLUSIONS

This clinical focus article proposes a theoretical framework and provides a practice example for addressing the intersecting identities of individuals with severe disabilities. Furthermore, this clinical focus article argues that identity is a basic human right and area in which additional efforts are needed in the application of AAC solutions.

Perceptions and experiences of control among people living with motor neurone disease: a systematic review and thematic synthesis

PURPOSE

Current research suggests that feeling a lack of control is common among people living with Motor Neurone Disease (plwMND). This systematic review explores and synthesises evidence about: (1) What factors contribute towards perceptions of control in plwMND (2) How do plwMND attempt to maintain control in their daily lives?

METHODS

A systematic search from inception to January 2022 for peer-reviewed journal articles in English reporting qualitative and mixed-method primary studies or reviews of plwMND's perceptions or experiences of control was conducted on CINAHL, MEDLINE, PsycINFO, ASSIA, Embase and AMED. Eligible articles underwent quality appraisal, data extraction and a thematic synthesis was carried out.

RESULTS

Twenty publications, 19 primary studies and one review, from nine countries, reporting the views of 578 participants aged from 20 to 90 years were included. Two key analytical themes were identified (1) diagnosis can lead to a disruption of previously held control beliefs (2) plwMND use a range of control strategies to attempt to retain control in their lives.

CONCLUSION

This is the first systematic review and qualitative evidence synthesis to reveal the strategies plwMND use to regain control and that control beliefs about health, fate, identity and bodily control are significantly altered by the diagnosis. Implications for rehabilitationOutcome measures for plwMND should consider personal values and preferences as well as objective clinical measurements.plwMND use a range of control strategies which may alter and change over time therefore healthcare professionals may also need to review and adapt treatment decisions over time.The differing viewpoints of healthcare professionals and plwMND should be considered in clinical situations to reduce the potential for conflict.

The BCH message banking process™, voice banking, and double-dipping™

Significant advances have been made in interventions to maintain communication and personhood for individuals with neurodegenerative conditions. One innovation is Message Banking, a clinical approach first developed at Boston Children's Hospital (BCH). This paper outlines the Message Banking process as implemented at BCH, which includes the option of "Double Dipping," where banked messages are mined to develop personalized synthesized voices. More than a decade of experience has led to the evolution of six core principles underpinning the BCH process, resulting in a structured introduction of the associated concepts and practices with people with amyotrophic lateral sclerosis (ALS) and their families. These principles highlight the importance of assigning ownership and control of the process to individuals with ALS and their families, ensuring that as a tool it is empowering and offers hope. Changes have been driven by feedback from individuals who have participated in the BCH process over many years. The success of the process has recently been extended through partnerships that allow the recorded messages to be used to develop individual personalized synthetic voices to complement banked messages. While the process of banking messages is technically relatively simple, the full value of the process should be underpinned by the values and principles outlined in this tutorial.