A communication board is a tool that allows a person to express thoughts, needs, feelings, and choices without speaking. It can be as simple as a laminated sheet with pictures, or as advanced as a touchscreen device that converts symbol selection into spoken words. Communication boards belong to the broader category of Augmentative and Alternative Communication (AAC).

What Is a Communication Board?

A communication board displays symbols, pictures, letters, words, or a mix of these. The user points to, touches, or selects the relevant item to communicate. The symbols can be photographs, line drawings, colour pictures, or printed text, depending on the user's ability and age.

They are used by people of all ages who have difficulty speaking clearly or fluently. The goal is always the same: to give the person a reliable, effective way to communicate.

Where Are Communication Boards Used?

• Hospitals and ICUs - Patients who are intubated, sedated, or recovering from surgery often cannot speak. Communication boards help them tell medical staff about pain, discomfort, or needs.
• Special education classrooms - Children with complex communication needs use boards daily during lessons and activities.
• Therapy sessions - Speech-language therapists use boards to build language skills.
• Home settings - Boards are placed in kitchens, bedrooms, and play areas so communication happens throughout the day.
• Community settings - Shops, clinics, and public places increasingly use boards to help non-speaking individuals express basic needs.
• Rehabilitation units - After stroke, brain injury, or surgery affecting speech.

Conditions Where Communication Boards Are Commonly Used

Types of Communication Boards

Communication boards are broadly divided into low-tech and high-tech types.

1. Paper-Based Picture Boards (Low-Tech)

These are printed sheets with symbols, photographs, or drawings. Symbols may represent objects, actions, feelings, or places. They are durable when laminated, inexpensive, and do not need electricity or charging.

• Ideal as a first AAC tool
• Easy to customise for the individual
• Can be used anywhere, including water environments and outdoors where screens are difficult to see

2. PECS - Picture Exchange Communication System

PECS is a structured, research-based method where the user physically hands a picture card to another person to communicate a request. It follows a six-phase training programme developed by speech-language pathologists Lori Frost and Andy Bondy. It is widely used with young children and those with autism.

3. Core Vocabulary Boards

These boards display high-frequency words - words used most often in daily life, such as "I", "want", "go", "help", "stop", "more", "no". Research shows that approximately 300 core words make up around 80% of everyday speech. Core boards help users build short meaningful sentences rather than just label objects.

4. Alphabet and Letter Boards

These display the letters of the alphabet, allowing literate users to spell out any word or sentence. They are used by people with conditions such as ALS, acquired aphasia, or motor conditions where speech is absent but literacy is intact. Some systems use a combination of letter boards and word prediction.

5. Static Electronic Devices (Mid-Tech)

These are battery-operated devices with pre-recorded messages attached to picture symbols or buttons. Pressing a button plays a recorded spoken message. They have a fixed layout that does not change.

• Example type: single-switch devices, sequential message recorders
• Useful for early communicators or those needing a small, focused vocabulary

6. Dynamic Display Devices / Speech Generating Devices (SGD) - High-Tech

These are electronic devices with screens that change pages or vocabulary sets based on selections made. They use synthesised (computer-generated) or digitised (recorded human) speech to speak aloud what the user selects. They are also called Voice Output Communication Aids (VOCAs).

• Can hold thousands of vocabulary items
• Vocabulary pages change dynamically (e.g. selecting "food" opens a food vocabulary page)
• Allow full sentence building
• Can connect to environmental controls (lights, TV) in some advanced versions

7. Touchscreen AAC Apps (Tablet-Based)

AAC software installed on a standard tablet (such as an iPad or Android tablet) functions similarly to a dedicated SGD but at lower cost. The user taps symbols on the screen which are then spoken aloud. Well-known app types include grid-based systems (where symbols are arranged in rows and columns) and visual scene displays (where symbols are placed within a photograph of a real setting).

How to Use a Communication Board: Step-by-Step

Setting Up (First Time)

Daily Use - How to Communicate With the Board

Accessing a Touchscreen AAC App

Vocabulary Placement on a Board

The arrangement of symbols matters. Common systems include:

• Fitzgerald Key - A colour-coded system where people are yellow, verbs are green, describing words are blue, and so on. Used in many professional AAC systems.
• Motor planning layout - Symbols are always in the same location to build muscle memory. This is the basis of motor planning approaches used in some SGDs.
• Semantic (meaning-based) layout - Words are grouped by topic or category.

An SLP chooses the most appropriate layout for each person based on their learning style and cognitive profile.

Precautions and Important Points

General Precautions

• Always have a backup board. Electronic devices run out of charge, break, or become unavailable. A paper board should always be available as a backup. Never let someone be without a way to communicate.
• Do not limit vocabulary artificially. All people, regardless of disability, deserve access to a full vocabulary including words to express pain, emotion, personal preferences, and social conversation - not just basic needs.
• Never remove the board as a consequence or punishment. This removes the person's only means of communication and is ethically unacceptable.
• Respect the communication attempt. If the user is pointing or reaching, always stop and listen. Communication attempts should never be ignored.
• Do not speak for the user. Allow them to form their own message. Finishing sentences for someone discourages independent communication.

For Touchscreen and Electronic Devices

• Keep devices charged. A flat battery means no communication access.
• Use protective cases to prevent damage from drops.
• In bright sunlight, the screen may be difficult to see. Have a non-screen backup ready.
• Touchscreen devices used by children should have AAC app locks or guided access enabled to prevent the device from being used for non-AAC purposes during communication time.
• Clean screens regularly as they are touched frequently, especially in shared or clinical settings.

Screen Time Note for Children

For children using tablet-based AAC, the device is a communication and therapeutic tool, not entertainment media. Guidance from the American Academy of Pediatrics and the World Health Organization on recreational screen time does not apply to medically recommended AAC use. However, the device should be configured so it is used specifically for communication rather than passive entertainment.

Physical Access Considerations

• Users with limited hand control may need eye gaze technology, switch access, or head pointer access rather than direct touch.
• Boards should be placed at a comfortable angle - not flat on a table when the user is seated, as this strains the neck.
• Ensure good lighting so symbols are clearly visible.
• Symbols should be large enough for the user's vision level.

Keeping a Communication Board in Good Condition

Paper and Low-Tech Boards

• Laminate all paper boards to make them wipe-clean and durable.
• Store boards flat or in a rigid folder to prevent bending.
• Replace symbols that become faded, torn, or dirty as unclear symbols lead to communication errors.
• Wipe down with a damp cloth regularly, especially in healthcare settings.
• Make duplicate copies of important boards and store them safely.
• If velcro symbols are used, check that velcro is still firmly attached and replace worn pieces.

Electronic and Touchscreen Devices

• Use a screen protector and a robust protective case.
• Charge the device every night to ensure it is always ready.
• Backup the device vocabulary settings regularly using the app's cloud or export function. If a device is lost or broken, vocabulary can be restored quickly.
• Clean the touchscreen with a microfibre cloth. Avoid chemical sprays that can damage the screen.
• In healthcare settings, follow the device manufacturer's disinfection guidelines. Some covers are designed to withstand clinical-grade cleaning.
• Keep software and the AAC app updated to avoid glitches and to access improved features.
• Have the device serviced or repaired promptly if it develops faults, as it is a medical communication tool.

Additional Practical Points

Who Sets Up and Manages AAC?

The primary professional is a Speech-Language Pathologist (SLP, also called Speech-Language Therapist or SLT in some countries). They conduct a formal assessment, recommend the appropriate board type and vocabulary, provide training, and monitor progress. In hospital settings, the treating team, occupational therapists, and nurses are often involved as well.

Funding and Access

Access to communication devices varies significantly by country. In many places, high-tech SGDs may be funded through government disability support schemes, health insurance, school systems, or charitable organisations. Low-tech boards are typically inexpensive to make or buy. In countries with national disability frameworks (such as the NDIS in Australia, or similar schemes in the UK, Canada, and parts of Europe), AAC devices may be fully or partially funded after an assessment. Consulting a local SLP or disability services organisation provides the most accurate information for a specific region.

Involving Everyone

Communication boards work best when everyone who interacts with the user - at home, at school, at the clinic, in the community - understands how the board works and models its use. Training sessions with key people are an important part of the AAC process.

When to Update a Board

Boards should be updated regularly as the user's vocabulary needs grow, as their communication skills develop, or as their life circumstances change (new school, new activities, new health situation). An AAC board that is too limited holds back communication development.

Frequently Asked Questions (FAQ)

Suggested Resources for Further Reading

Medically reviewed by a Paediatrician. | PediaDevices - A Practical Guide to Devices in Child Healthcare.