Tap the screen. Point to the symbol. Press the button. Most AAC systems quietly assume the user has a hand that moves where the brain asks it to — and for children with conditions like cerebral palsy or spinal muscular atrophy, that assumption falls apart.
This article is about the ways in — the alternative access methods that let a child operate a communication system with their eyes, a switch, a head movement, or a trusted partner. It's not about whether communication will support or slow down speech development (it supports it — see Speech Generating Devices: What They Are for the research), because for many of the children we're talking about here, reliable access to any voice at all is the question on the table. The companion article, Choosing the Right Access Method, walks through how the assessment actually unfolds.
What Is Alternative Access?
Alternative access refers to any method of interacting with a communication system that doesn't rely on direct pointing or touch with the hands. It's about finding the movement — however small — that a child can control reliably, and using that movement as the gateway to communication.
The principle is simple: every child has a way to communicate. Our job is to find it. Finding the right access method is genuinely a team effort — typically alongside occupational therapists and physiotherapists — and a good fit can make a real difference.
Alternative access methods include:
Eye Gaze Technology
Eye gaze (also called eye tracking) is one of the most exciting developments in communication technology. A camera mounted below a screen tracks where your child is looking. By fixing their gaze on a symbol for a set amount of time, they make a selection — and the device speaks.
Eye gaze is ideal for children who have good control of their eye movements but limited or no use of their hands. Many children with cerebral palsy, particularly those classified at Gross Motor Function Classification System (GMFCS) levels IV and V, use eye gaze as their primary access method.
Modern eye gaze systems are remarkably accurate and responsive. Children as young as two or three years old have been successfully set up with eye gaze technology.
Switches
A switch is exactly what it sounds like — a button that your child activates to control a communication system. Switches come in all shapes and sizes, and they can be activated by almost any reliable movement:
- Pressing with a hand, fist, elbow, or knee
- Tilting the head
- Moving a foot
- Pressing a cheek or temple against a proximity switch
- Blowing (sip-and-puff switches)
Switches are often used with a scanning method, where options on the screen are highlighted one at a time (or in groups), and the child presses the switch when the one they want is highlighted.
Switch access takes time to learn, but it gives children with very limited movement a powerful way to communicate independently.
Partner-Assisted Scanning
For children who can't yet manage a switch or eye gaze system, partner-assisted scanning is a low-tech option that can be used immediately.
Here's how it works: the communication partner points to or names options, and the child indicates "yes" when the partner reaches the one they want. The "yes" signal might be:
- A smile or specific facial expression
- A vocalisation
- A head movement
- An eye blink
- Any consistent, reliable signal the child can produce
Partner-assisted scanning can be used with a communication book (like a PODD designed for partner-assisted scanning), a simple choice board, or even spoken options.
It's not as fast as direct selection, and it relies heavily on the communication partner — but it's available right now, requires no technology, and can be a bridge while other access methods are being explored. For many families, partner-assisted scanning makes back-and-forth conversation with their child much easier to share. When I've supported children with complex physical disabilities, the breakthrough moment is often the first time an adult slows down enough to wait for a tiny, consistent "yes" signal — and realises the child has been ready to talk all along.
Head Tracking and Other Motion-Based Systems
Some systems track head movement using a reflective dot or camera, allowing children with reliable head control to move a cursor on screen. Others use joystick-style controllers that can be operated with a chin, foot, or other body part.
They can suit children with some controlled movement but not enough for accurate touchscreen use. How fast, accurate and tiring each method is varies from child to child, so the team compares them in supported trials rather than ranking them in advance.
Why Alternative Access Matters
The Australian Cerebral Palsy Register tells us that a significant proportion of children with cerebral palsy have communication difficulties, and many have physical limitations that prevent them from using standard communication tools without adaptation (ACPR Group, 2023).
Without alternative access, these children face a stark reality: they might understand everything going on around them but have no way to express their thoughts, needs, feelings, or ideas. That's not just a communication problem — it affects every aspect of a child's life, from education and social participation to emotional wellbeing and self-determination.
Professor Iona Novak and colleagues' systematic reviews of interventions for children with cerebral palsy have highlighted the importance of AAC — including appropriate access methods — as an evidence-based approach to supporting communication and participation (Novak et al., 2020). Good access can open up many more chances to communicate. How much it helps varies from child to child, which is why the team keeps checking whether the system is actually working in daily life.
Speech Pathology Australia's AAC Clinical Guideline recognises that all individuals have the right to communicate, and that access to appropriate AAC — including alternative access methods — is essential for children with complex physical needs (Speech Pathology Australia, 2012).
Access Assessment: Finding the Right Method
Choosing the right alternative access method isn't a one-size-fits-all decision. It requires a careful assessment that looks at:
- Motor abilities: What movements can your child control reliably and consistently? This includes not just hands and arms, but head, eyes, feet, and any other body part.
- Seating and positioning: A child's access to a communication system is heavily influenced by how they're positioned. Good postural support can make the difference between successful and unsuccessful access.
- Vision: Eye gaze technology requires adequate visual skills. Other methods may also need specific visual abilities.
- Cognition and language: The access method needs to match your child's understanding and developmental level.
- Fatigue: Some access methods are more tiring than others. The right method is one your child can use comfortably throughout the day.
- Environment: Where will the system be used? Some methods work better in quiet, controlled settings; others are more portable.
This assessment is best done by a team — a speech pathologist, an occupational therapist, and often a physiotherapist, working together to understand your child's abilities and find the best fit. In Australia, assistive technology specialists and suppliers can also contribute expertise about available equipment.
The Right to Communicate
Every child deserves a way to express themselves. Alternative access methods make that possible for children whose bodies don't allow them to simply point or tap. Whether it's through their eyes, a switch, a partner's support, or head movement, the goal is the same: making it easier for your child to say what they want to say.
Every child deserves to be heard, and alternative access makes that possible. If your child has a physical disability and you're wondering how they can access communication technology, we work collaboratively with OTs, physios, and families across Brisbane to find the right solution. Get in touch to start exploring the options together. Any actual clinical work — assessment, diagnosis, or therapy — happens in a consultation about your child, not from an article.
References
- Australian Cerebral Palsy Register (ACPR Group). (2023). Australian Cerebral Palsy Register Report. Cerebral Palsy Alliance.
- 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.
- Speech Pathology Australia. (2012). Augmentative and Alternative Communication Clinical Guideline. Speech Pathology Australia.
Ready for practical strategies? Read our companion article: Choosing the Right Communication Access Method: A Guide for Brisbane Families
Alexandra Bouwmeester is a Senior Speech Pathologist (MSPA, CPSP) with specialist PODD training and over 14 years' experience in collaborative AAC assessment alongside OTs and physios. She offers mobile speech pathology to families across Brisbane's south side and Logan.
