Clinical AAC Specialist Becky and Assistive Technology (AT) Specialist Anna explore why having the right access method is so important, and the role dual access can play. Drawing on clinical insight and real-world experience, they aim to raise awareness of access, and the possibility that looking beyond a single access route may support more reliable communication for some people who use AAC, ensuring systems truly reflect the dynamic needs of the individual.
Why we're talking about access
Sharing knowledge feels especially important in AAC because we all sit at different stages of learning and experience. No two people are the same, and what one AAC user may benefit from exploring could look very different to another, even with the same diagnosis or at a similar life stage.
I am passionate about making sure that we learn from the powerful knowledge gained from the lived experience of people who use AAC, and that we share and amplify those golden nuggets of information far and wide.
As it’s Cerebral Palsy Awareness Month, there are many valuable areas we could explore: inclusion, communication growth, robust vocabulary systems, regulation, modeling, and presuming potential. All of these matter deeply.
Becky
Clinical AAC Specialist
Alongside these areas, we felt strongly that something equally fundamental needs more attention and exposure: access, and more specifically, dual access.
- Access refers to the method(s) that enable someone to physically and reliably control their AAC system.
- Dual access is the intentional use of two access methods.
This month, we’re bringing Anna’s real world insight into the conversation. As an AT Specialist working directly with individuals across a range of settings, she brings practical experience of what access looks like in everyday life, not just in assessment rooms, but across homes, schools, hospitals and communities.
Insights from Anna
As an Assistive Technology Specialist, I assess people in their homes, hospitals, nursing homes and health centres to support communication device use. I’m often asked to determine the most appropriate access method, which can be surprisingly complex.
Over time, I’ve learned that sometimes one access method isn’t enough. A person may do well most of the time, but at certain points in the day, such as when tired, in a different environment or when symptoms fluctuate, that same method can become frustrating or slow.
That’s where dual access can help. It isn’t suitable for everyone, and it requires careful planning, but when it fits, it can make communication more reliable, faster and less effortful.
Anna
AT Specialist
Real life examples
I visited a woman living with multiple sclerosis who used direct touch. In the morning, she selected words quickly and accurately. By late afternoon, her fingers became stiff and inaccurate.
She sighed and said: “It works fine in the morning, but by late afternoon my hands just won’t do it.”
We trialed a small switch activated by her knee. It didn’t replace touch, it complemented it. When fatigue set in, she had another way. Her smile when she realized she could continue communicating said everything.
I’ve seen similar patterns in someone living with ALS. Eye gaze worked well at home, but fatigue made holding gaze for selection difficult. Adding a shoulder-activated switch for confirmation reduced strain and made longer messages manageable again.
For a gentleman with Parkinson’s, direct touch worked early in the day, but tremor and fatigue later caused frustration. Pairing head tracking for cursor movement with a switch for selection restored speed and confidence.
Staff initially thought he had lost motivation to communicate, when in reality, he needed more reliable access under changing conditions.
What can dual access look like?
Switches can be activated in a number of ways, with: fingers or hands, feet, knees, elbows, shoulders, head, jaw and eye gaze.
Supporting features like auditory cues, keyguards and word prediction can also make access more efficient.
Common combinations include:
- Eye gaze + switch
- Head tracking + switch
- Touch + switch
- Eye gaze + head tracking
- Knee or foot switch + eye gaze
Not every combination works. Sometimes it’s trial and error. Sometimes it’s simply not needed. And that’s okay.
Feature matching the AAC system to the person and their everyday life
Communication systems must reflect how people live and move, not just what works during a structured assessment.
Some mornings, a single method is perfect. Some afternoons, dual access enables continued participation without fatigue. For others, a second method may never be necessary.
Dual access isn’t about complexity for complexity’s sake. It’s about options; giving someone a reliable way to communicate when their body, energy or environment shifts.
Seeing someone continue to ask questions, participate or joke because they can adapt between methods is one of the most rewarding parts of this work.
Anna is an Assistive Technology Specialist with over 10 years’ experience in AAC and AT across clinical, community and commercial settings in Ireland. She specializes in person-centred AAC assessment, alternative access methods and long-term assistive technology planning for children and adults with complex communication needs. In her role at Smartbox, Anna is involved in assessments, implementation and training across the Republic of Ireland and Northern Ireland, with a particular focus on access optimisation, eye gaze, switch access and user interface design.
In summary: when might dual access be helpful?
Dual access might be helpful in a number of different circumstances, for example:
- When motor control fluctuates throughout the day, such as commonly experienced with cerebral palsy.
- When environmental conditions change.
- When progressive conditions are present (ALS, MS, Parkinson’s).
- When communication demands are high.
- When single-method use becomes inconsistent or ineffective.
Closing thoughts
If we truly believe communication is a human right, then exploring access, and considering dual access, isn’t optional. It’s foundational. This blog isn’t suggesting that access must be the first competency an AAC user masters. Strategies such as modeling without demand or expectation remain essential. However, our thinking is this: let’s ensure someone can access their system reliably enough for modeling to truly matter. Let’s be diligent in thoroughly exploring appropriate access methods and, where possible, consider dual access as part of that process.
Our hope is that through Anna’s insights and real-life examples, this blog offers refreshment, reassurance and renewed curiosity around access.
There is so much we can learn from one another. Often, when a tricky situation is shared, it becomes lighter, or at least less lonely. And from there, we reflect, adapt and find solutions that support meaningful, positive outcomes for the AAC users we work alongside.