Dawn

AAC for ALS and MND

ALS (called motor neurone disease, or MND, in the UK) usually affects speech. In Dawn you can record a voice sample and save phrases in your own voice. If speech or hand movement gets harder, it also has typing, saved phrases and switch scanning.

Dawn's Create a voice screen on iPad: 'Say a few sentences.' above a short passage and a record button

An estimated 80 to 95 percent of people with ALS eventually need another way to communicate besides speech.1 In one four-year study, 96% of participants accepted AAC when it was offered.2 UK guidance says communication aids should be provided "without delay".3

Before speech changes

Record a voice. Read a short passage for about eight seconds and Dawn builds a voice from it on your iPhone or iPad in about half a minute. If you don't like the result, record again. How voice banking works in Dawn.

Record phrases. Nicknames, greetings, jokes, "I love you", the way you call the dog. These play back exactly as you recorded them. Message banking was developed at Boston Children's Hospital in work with people with ALS, with the person and their family deciding what to record.4 We have a list of ideas for what to record.

Try the app now and then, so you know your way around it before you rely on it.

In one interview study, people with MND who banked their voice said they did it mainly to keep something of who they are. Some people in the same study decided not to.5

Dawn's Message banking screen: record a phrase, and a saved recording 'Love you loads' on the Quick Phrases board
A recorded phrase saved to the Quick Phrases board.

Typing and phrases

Typing lets you say things that aren't on the board or in your saved phrases. Dawn suggests words as you type and speaks in the voice you chose, including one made from your recording. Things you say every day, like care routines or "give me a minute to type", can go in the Phrases tab, where they take one tap.

Caregivers in one study said people used their devices for personal conversations as well as everyday requests.6

Dawn's Type view on iPad with the message 'I have something to say.' above a large keyboard
The Type view.

When your hands get weaker

You can make buttons bigger, require a short hold before a tap counts, and have Dawn ignore accidental double taps. Dawn's switch scanning moves through the board, keyboard and phrases by row, column or block, with one switch or two, and can speak or click each item as it's highlighted. iOS Switch Control, head tracking and Eye Tracking work with every button too.

Many people with ALS later use a dedicated eye-gaze device, and Dawn doesn't include eye-tracking hardware. An AAC specialist or occupational therapist can help you plan for that, and your ALS clinic can refer you for a speech-language pathologist's assessment.

Dawn's board on iPad with switch scanning highlighting the bottom row
Row scanning: the highlight moves down the rows, then across the chosen row.

For partners and families

In a recent US survey, fewer than half of people with ALS said their family had received any advice or training about communication.7 Give the person time to type, don't finish their sentences unless they ask you to, and keep the device charged and within reach. We wrote a guide on talking with someone who uses AAC for family and friends.

Questions people ask

When should I start?

Ask for an AAC assessment while your speech is still clear. Researchers recommend an AAC assessment while speech still works, because speech can change quickly, and a slower speaking rate usually comes before people find you hard to understand.1 Recordings made while your voice is strong also give a better result.8

What have studies found about people with ALS using AAC?

In one four-year study, 96% of participants accepted AAC when it was offered, and none who started stopped using it.2 In a 2021 US survey, over 90% of people with severe speech impairment were using a speech-generating device.7

What happens when my hands get weaker?

Buttons can be made bigger, taps can need a short hold, and Dawn has its own switch scanning for one or two external switches. iOS Switch Control, head tracking and Eye Tracking also work with every button. Many people with ALS move to a dedicated eye-gaze device later; ask an AAC specialist when to look at that.

Can my family hear my recordings if I'm not using the app much yet?

Yes. Recorded phrases play from the Quick Phrases board, and the voice built from your recording can read anything someone types. Recordings are also included in Dawn's backup file.

Will insurance pay for this?

Medicare covers speech-generating devices for people with ALS through equipment suppliers after an SLP evaluation. It doesn't cover ordinary phones or tablets, and Dawn is bought through the App Store, not billed to insurers. Some people use an app while they wait for a funded device, or alongside one. See paying for AAC.

Sources

  1. Beukelman D, Fager S, Nordness A. Communication support for people with ALS. Neurology Research International, 2011. pmc.ncbi.nlm.nih.gov/articles/PMC3096454
  2. Ball LJ, Beukelman DR, Pattee GL. Acceptance of augmentative and alternative communication technology by persons with amyotrophic lateral sclerosis. Augmentative and Alternative Communication, 2004. doi.org/10.1080/0743461042000216596
  3. National Institute for Health and Care Excellence. Motor neurone disease: assessment and management (NG42), recommendations 1.12. www.nice.org.uk/guidance/ng42/chapter/Recommendations
  4. Costello J, Smith M. The BCH message banking process, voice banking, and double-dipping. Augmentative and Alternative Communication, 2021. doi.org/10.1080/07434618.2021.2021554
  5. Cave R, Bloch S. Voice banking for people living with motor neurone disease: views and expectations. International Journal of Language & Communication Disorders, 2021. doi.org/10.1111/1460-6984.12588
  6. Fried-Oken M, et al. Purposes of AAC device use for persons with ALS as reported by caregivers. Augmentative and Alternative Communication, 2006. doi.org/10.1080/07434610600650276
  7. Peters B, O'Brien K, Fried-Oken M. A recent survey of augmentative and alternative communication use and service delivery experiences of people with ALS in the United States. Disability and Rehabilitation: Assistive Technology, 2024. doi.org/10.1080/17483107.2022.2149866
  8. MND Association. Information sheet 7D: Voice banking and message banking, January 2026 (PDF). www.mndassociation.org/sites/default/files/public/2026-01/7D-Voice-banking-and-message-banking.pdf

Try Dawn on iPhone or iPad

Symbols, typing and saved phrases, spoken in a natural voice. Dawn can also build a voice from about eight seconds of your own speech.

Requires iOS 17 or later.