New to this topic? Start with our companion article: Alternative Access for Communication: Supporting Children with Physical Disabilities in Brisbane
Choosing an access method is, in some ways, the most consequential decision in an AAC journey for a child with complex physical needs. Get it right and communication flows. Get it wrong and even the best-configured device in the world sits untouched on a tray.
The tricky part is that "right" is never obvious on paper — it's a question you can only answer through structured trials, careful observation, and honest conversations between the family and the team. This article walks through how those assessments actually unfold, the factors that tip the decision one way or another, what equipment is available in Australia, and how NDIS funding fits in. For a tour of the access methods themselves — eye gaze, switches, partner-assisted scanning, head tracking — start with Alternative Access for Communication.
How Access Assessments Work
An access assessment is a structured process where a team of professionals works with your child to identify the most reliable, efficient, and sustainable way for them to interact with a communication system.
Here's what typically happens:
Step 1: Observing Your Child's Movement
The first thing we look at is what movements your child can control. This isn't just about hands — we look at the whole body:
- Can they point with a finger, fist, or knuckle?
- Do they have controlled head movement?
- Can they reliably move their eyes to look at specific targets?
- Is there a foot, knee, elbow, or chin movement that's consistent?
- Can they produce a reliable "yes" and "no" signal?
We observe your child in their natural positions — in their wheelchair, on a mat, sitting with support — because how they're positioned affects what they can do.
Step 2: Trialling Access Methods
Once we have a picture of your child's movement, we trial different access methods to see what works best. This might include:
- Direct selection trials: Can your child accurately touch a screen (perhaps with adaptations like a keyguard, stylus, or head pointer)?
- Eye gaze trials: Does your child's eye movement reliably control a screen? We often trial this with dedicated eye gaze equipment.
- Switch trials: Can your child activate a switch consistently? We'll try different switch types and positions.
- Partner-assisted scanning trials: Can your child reliably signal "yes" when a partner presents options?
Trials happen over multiple sessions, because a child's performance can vary with fatigue, positioning, mood, and familiarity with the equipment. What a child does in their first session with new equipment rarely tells the full story — it's the second and third sessions, once the novelty has settled and they're more comfortable, where you see their true abilities emerge. I've often found that the quietest first session is followed by the most surprising second one, once the child has had time to work out what the equipment is actually for.
Step 3: Considering the Whole Picture
The best access method isn't just the one your child can use — it's the one that works best across their whole life. We consider:
- Speed: How quickly can your child make selections? A method that's too slow can be frustrating and limiting.
- Accuracy: How often does the right target get selected? Frequent errors are discouraging.
- Fatigue: Can your child sustain the method throughout the day, or does it become too tiring?
- Portability: Does the method work in all the environments where your child needs to communicate?
- Independence: How much does the method rely on a communication partner? More independent methods are generally preferred where possible, but partner-dependent methods are absolutely valid when needed.
Factors That Influence the Decision
Seating and Positioning
This cannot be overstated: positioning affects everything. A child who struggles to hit a switch from their wheelchair might do so easily with adjusted seating, a better tray height, or a different switch mount.
This is why occupational therapists and physiotherapists are essential members of the access assessment team. Good postural support provides the stable base from which controlled movement happens.
If your child's positioning changes (new wheelchair, growth spurt, change in physical abilities), access may need to be reassessed.
Vision
Eye gaze technology obviously requires adequate visual skills, but vision matters for all access methods. If your child has a visual impairment, we need to consider:
- Symbol size and contrast on the screen
- Screen positioning and distance
- Lighting conditions
- Whether auditory scanning (where options are spoken aloud rather than visually highlighted) might be more appropriate
Developmental Level and Experience
A child who is new to communication technology will need a different approach than a child who has been using AAC for years. We consider:
- Your child's understanding of cause and effect
- Their experience with making choices
- Their cognitive and language level
- What they've already tried and how it went
What Your Child Prefers
Whenever possible, your child's preferences matter. Some children take to eye gaze immediately and find switches frustrating. Others love the tactile feedback of a switch press. Some children are most comfortable with a trusted partner scanning for them.
We listen to your child — through their behaviour, their engagement, and their responses — and factor their preferences into the decision.
Technology Options Available in Australia
Australia has a strong assistive technology sector, and families have access to a good range of equipment. Here's an overview:
Eye Gaze Systems
Dedicated eye gaze devices are available from manufacturers including Tobii Dynavox, Smartbox (Grid Pad with eye tracking), and others. These integrate the eye gaze camera directly into the communication device.
Eye gaze can also be added to some existing tablets and computers using external eye tracking bars. This can be a more affordable option for trialling.
Switches
A wide variety of switches are available in Australia, from simple button switches to more specialised options:
- Button switches (e.g., Jelly Bean, Big Red) — pressed with hand, foot, head, or any body part
- Proximity switches — activated by coming close without needing to press
- Tilt switches — activated by head movement
- Sip-and-puff switches — activated by breathing
- Fibre optic switches — activated by the smallest movements, such as an eyebrow twitch
Switch interfaces connect to communication devices, computers, and tablets, and can be used for both communication and environmental control.
Switch Mounting
A switch is only useful if it's positioned correctly. Switch mounts (such as those made by Rehadapt, Daessy, or Mount'n Mover) attach to wheelchairs, tables, or beds and hold the switch exactly where your child can reach it reliably.
Getting the mounting right is a collaborative effort between the speech pathologist, occupational therapist, and sometimes the equipment supplier.
Communication Software
Most communication apps and software support multiple access methods. Systems like Grid 3, Proloquo2Go, LAMP Words for Life, and Snap + Core First can be configured for touch, switch scanning, eye gaze, or head tracking — and can be paired with a low-tech communication book as a back-up. Your speech pathologist will set up the software to match your child's access method.
Funding Access Equipment in Australia
The National Disability Insurance Scheme (NDIS) is the primary funding pathway for assistive technology, including alternative access equipment. The NDIS can fund:
- Eye gaze devices and cameras
- Switches and switch interfaces
- Mounting systems
- Communication software
- Trials and assessments
Assistive technology requests for the NDIS are typically prepared by an NDIS-registered AAC specialist or assistive technology assessor, often in collaboration with the child's wider therapy team. Your child's NDIS support coordinator or plan manager can help you find the right person.
For families not on the NDIS, some state-based equipment programmes, charitable organisations, and loan schemes may be able to help.
Working with the Team
Finding the right access method is rarely a one-person job. The team typically includes:
- Speech pathologist: Leads the communication assessment, selects and configures the communication system, and trains the family and other communication partners in strategies like aided language stimulation
- Occupational therapist and physiotherapist: Assess seating, positioning, and motor abilities; help with switch selection, mounting, and postural management
- Assistive technology specialist/supplier: Provides equipment for trialling, technical support, and set-up
- Family: You know your child better than anyone. Your observations and priorities are central to the process
Good teamwork means everyone is communicating (pun intended) and working toward the same goals for your child. A well-coordinated team — paediatricians, OTs, physios, and others — can find solutions that no single professional would have reached alone.
Access Is an Ongoing Process
One important thing to know: choosing an access method isn't a one-time decision. Your child's needs and abilities will change over time — with growth, development, medical changes, and new technology. Regular review is essential to make sure the access method is still working well.
What's perfect at age three may need adjusting at age six, and again at age ten. That's normal and expected.
Let's Find the Right Fit
We conduct thorough access assessments, trial equipment, configure systems, and provide ongoing support as your child grows — always in collaboration with your child's wider team. Get in touch to talk about your child's access needs and what the next step might be. Any actual clinical work — assessment, diagnosis, or therapy — happens through a proper consultation tailored to your child.
References
- Novak, I., Morgan, C., Fahey, M., Finch-Edmondson, M., Galea, C., Hines, A., ... & Badawi, N. (2020). State of the evidence traffic lights 2019: Systematic review of interventions for preventing and treating children with cerebral palsy. Current Neurology and Neuroscience Reports, 20(2), 3.
- Light, J., & McNaughton, D. (2015). Designing AAC research and intervention to improve outcomes for individuals with complex communication needs. Augmentative and Alternative Communication, 31(2), 85–96.
- Speech Pathology Australia. (2020). Augmentative and alternative communication clinical guidelines. Speech Pathology Australia.
Alexandra Bouwmeester is a Senior Speech Pathologist (MSPA, CPSP) with over 14 years' experience in collaborative access assessments alongside OTs and physios. She works with families across Brisbane's south side and Logan.
