Often simple manual systems are preferred because they permit continuing human contact without requiring the higher levels of energy, technical knowledge and skill and motivation needed to operate more sophisticated equipment.

Communication Boards
Writing boards (for example, white boards, magic slates) are often the preferred choice when you can still write. Once grip is impaired, your gaze is often an efficient and reliable method of communicating. Communication boards that use gaze usually feature alphabet letters, symbols and/or complete words, phrases, or sentences. To use the board, you point to, look at, or use a device or otherwise indicate the desired communication. Words usually included on communication boards are lists of foods, comfort items and positioning requests. The more information there is, the larger the board must be.

When only face-to-face communication is needed and you can still indicate selections on a board by pointing or eye movements, a word or letter board is a good low-tech communication choice.

Signalling Systems
These no-cost systems are usually worked out between you and your regular communication partners. Signalling makes use of facial expressions, eye contact, eye movements, gestures, touch and body language. Some of this system's drawbacks include the limited nature of possible responses and the inability to communicate with people who are unfamiliar with the system.

Personal signalling systems are a valuable backup to high-tech systems that are vulnerable to system failure.

However, a 24-hour monitoring alarm (for example, a bell, intercom, or buzzer) is necessary to enable you to request attention.

You and your family may want to apply for an emergency response service. Those who join are given a small (about the size of a small box of matches) transmitter with an emergency button on it.

When joining this program people advise the service of :

• Facts about their illness;
• The names and phone numbers of people who should be contacted in case of emergency.

When the person presses the emergency button on the small transmitter, a signal is sent to the service that tells them who has the emergency. They will know the patient's illness and immediately call the names given to them for emergency purposes.

Communication Assistive Devices
If you cannot speak you may prefer to write or type out messages as long as you are able to do so. Assistive devices to aid manual communication include pencil grips, magic slates and other portable boards, book holders, tilt-top tables, pointers, typing sticks (held in the mouth, hand, or foot), writer's splints, TTY (teletyper), TTD (telephone for the deaf), and page turners. If you leave home without a caregiver, it may be wise to wear a medical emergency bracelet.

A palatal lift or other hard-palate prosthesis may be considered as a short-term option in cases where existing speech can be improved. A prosthesis may improve swallowing and reduce problems associated with excessive salivation. However, oral devices cannot compensate for a lack of speech caused by weakness or paralysis of the lips, tongue, larynx or breathing muscles. Also, as ALS is dynamic, a prosthesis may not be a realistic option in cases where there is rapid change in communication function and control. You should consult a speech-language pathologist or prosthodontist to determine your best option.

Specialized Telephone Equipment
Special phone services are available. If you are unable to lift a phone receiver and/or dial a phone number, there is a hands-free phone, activated by blowing on a switch, plus an operator dialing service. Speaker phones may also be helpful. See your local phone book for the specialized services in your area.