Dawn

AAC for cerebral palsy

Cerebral palsy can affect the muscles used for speech and the hands used for pointing. If both speech and touch are hard, the person needs a communication app they can work with a switch or another control.

Dawn's symbol board on iPad in switch scanning mode, with the bottom row highlighted and a Stop scanning button

Cerebral palsy affects movement, often including the movements of speech. In a review of 30 population studies, 1 in 4 children with cerebral palsy could not talk.1 In a Swedish study of 129 children, more than half had a speech disorder or no speech.2 Many of these children understand language well.

Research

A systematic review of nine studies with 294 people found moderate-quality evidence that AAC improves both understanding and expression in people with cerebral palsy.3

In a Norwegian study of preschoolers with cerebral palsy, about a third needed AAC, but only 11 of those 35 children had a communication aid. Parents of children who had one said they used it often and were satisfied with it.4

There is little research on eye-gaze control.5 An AAC specialist can help the person try different controls and compare how reliably they can use them.

Dawn's access options

  • Switch scanningDawn highlights buttons in turn and the user selects with a switch. It can scan row then column, column then row, in blocks (a quarter of the board at a time, which saves presses on big grids), or one button at a time. Use one switch with automatic scanning, or two switches to step and select. Timing, the pause after a selection and the highlight style can all be changed.
  • Auditory scanningDawn can speak each item, or click, as the highlight moves, for people who scan by listening.
  • What scanning coversThe board, keyboard, phrases, message window and view switcher. Speak, delete and Stop are always in the cycle.
  • Bigger buttons3 × 4, 4 × 6 and 5 × 7 grids.
  • Touch settingsA hold time before a tap counts, so brushing the screen doesn't select anything, and an option to ignore repeated taps from a tremor or spasm.
  • Apple's built-in accessiOS Switch Control, head tracking and Eye Tracking work with every button in Dawn.
Dawn's board in switch scanning mode with the bottom row highlighted in blue
Row scanning, with the bottom row highlighted.

Dawn doesn't include switches, mounts or eye-gaze cameras, and it isn't a rugged dedicated device. For some people, especially those whose only reliable access is eye gaze, a dedicated device arranged through a specialist assessment is the better choice. Some families use both. The paying for AAC guide covers funding.

Setting up

  1. Watch which movement your child makes most reliably and with least effort.
  2. If touch is possible, try it first with a larger grid and a hold time; your therapists can help you judge when switches would be easier.
  3. If you move to switches, start with slow automatic scanning and a few words, and speed up later.
  4. Use the board yourself while you talk, so your child sees where words are.

An occupational therapist and a speech-language pathologist who know AAC can help choose the access method, the switch and where to mount it, so ask for an assessment with both.

Questions people ask

My child can't tap accurately. Can they still use an app?

Often, yes. Dawn's buttons can be made much bigger with the 3 × 4, 4 × 6 and 5 × 7 grids, it can wait for a deliberate hold before a button activates, and it can ignore repeated taps. If touch isn't reliable at all, switch scanning lets a child choose words with one or two switches, pressed with a hand, head, knee or foot.

Does Dawn support eye gaze?

Dawn doesn't include its own eye-gaze system. Apple's Eye Tracking, head tracking and Switch Control are built into iPhone and iPad, and they work with every button in Dawn. Dedicated eye-gaze devices use separate cameras and are usually arranged through a specialist assessment. A systematic review found only two small studies of eye-gaze control in cerebral palsy.5 If eye gaze is your child's best access, talk to an AAC specialist about which setup suits them.

Is my child too young, or is their understanding too limited, for AAC?

ASHA says there are no prerequisites for AAC, and that impaired cognition does not rule out communication.6 Speech and movement alone may not show how much a child understands, and AAC gives them another way to respond.

What switches work with Dawn?

Dawn's scanning works with Bluetooth switch interfaces that send key presses, and you can remap which keys select and which advance; Space and Return always select. Apple's Switch Control also works across Dawn if you use it for the rest of the device. An occupational therapist can help with switch type and where to mount it.

Is Dawn suitable for adults with cerebral palsy?

Yes. Adults can use the full board, the keyboard with word suggestions, saved phrases and an adult voice, with the same access settings.

Sources

  1. Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics, 2012. doi.org/10.1542/peds.2012-0924
  2. Nordberg A, Miniscalco C, Lohmander A, Himmelmann K. Speech problems affect more than one in two children with cerebral palsy: Swedish population-based study. Acta Paediatrica, 2013. doi.org/10.1111/apa.12076
  3. Avagyan A, Mkrtchyan H, Shafa FA, Mathew JA, Petrosyan T. Effectiveness and determinant variables of augmentative and alternative communication interventions in cerebral palsy patients with communication deficit: a systematic review. CoDAS, 2021. doi.org/10.1590/2317-1782/20202020244
  4. Lillehaug HA, Klevberg GL, Stadskleiv K. Provision of augmentative and alternative communication interventions to Norwegian preschool children with cerebral palsy: are the right children receiving interventions? Augmentative and Alternative Communication, 2023. doi.org/10.1080/07434618.2023.2212068
  5. Karlsson P, Allsop A, Dee-Price BJ, Wallen M. Eye-gaze control technology for children, adolescents and adults with cerebral palsy with significant physical disability: findings from a systematic review. Developmental Neurorehabilitation, 2018. doi.org/10.1080/17518423.2017.1362057
  6. American Speech-Language-Hearing Association. Augmentative and Alternative Communication (Practice Portal). www.asha.org/practice-portal/professional-issues/augmentative-and-alternative-communication
  • Choosing an AAC appWhat to check when choosing an AAC app: word layout, voice, access, offline use, privacy and trials.
  • How to start AACSetting up AAC and using it with your child in the first few weeks.
  • Paying for AACWhat Medicare, Medicaid, schools and the NHS cover, and where apps fit in.
  • AdultsTyping, saved phrases and symbols, spoken in a built-in voice or one made from your recording.

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.