Nearly 5 million Americans require augmentative and alternative communication (AAC) methods to meet their
daily communication needs. Some of these high-need individuals have motor impairments so severe (due to
conditions such as brainstem stroke, traumatic brain injury, Guillain Barré syndrome, and cerebral palsy, among
other disabilities) that they do not have the manual dexterity to control AAC technology and require alternative
access methods (such as eye-tracking, head-tracking, or switch-scanning). Existing solutions, however, require
extensive maintenance, frequent re-calibrations, and manual interface modifications that must be carried out
with continued assistance from a caregiver or by compensating via their own residual motor activity. The
excessive workload of adapting to these alternative communication methods are among the leading causes of
AAC abandonment, ultimately depriving this population of their fundamental right to communication. To meet
the critical communication needs of individuals with severe motor impairments, we propose the first AAC
device comprising a versatile access method that automatically learns and customizes a keyboard interface to
the residual motor function of the individual. In Phase I, we established the feasibility of developing a
personalized keyboard interface (limited to A–Z, space) based on an individual’s cursor movement and target
selection abilities using a combined surface electromyographic (sEMG) and inertial (IMU) access method placed
on their forehead. When evaluated amongst individuals with and without severe motor impairments, our AAC
solution achieved greater information transfer rates (ITRs) over the standard QWERTY keyboard. Having
successfully demonstrated this proof-of-concept, we are collaborating with speech researchers and clinicians at
Boston University, MA (STEPP Lab for Sensorimotor Rehabilitation Engineering) and Madonna Rehabilitation
Hospital, NE (Institute for Rehabilitation Science and Engineering) to advance our Phase I system into a pre-
commercial MyAACTM system comprising versatile access method and personalized, comprehensive
communication software. We will achieve this by developing hardware to support streamlined access across
multiple points on the body (Aim 1), designing automated algorithms to rapidly create an expanded AAC
interface, inclusive of letters, numbers, symbols, emojis, and word completion options, that is personalized based
on the residual motor function of user-specific access points (Aim 2), creating software for point-of-care use of
the access technology and interface, and evaluating the resulting MyAACTM system for communication efficacy
in individuals with severe motor impairments (Aim 3). Our milestone will be to demonstrate that MyAACTM
improves ITR and user experience over conventional AAC devices. The final MyAACTM deliverable will be easily
integrated with existing AAC tablets and mobile devices to provide those in need of alternative communication
methods with an automatically customized, efficient, and intuitive solution to restore communication access in
their daily lives.