This is a plain-language summary of a journal article. The article is one of 21 articles in a special issue of the AAC journal (Volume 41, Issue 3, 2025). All the articles are written or co-written by AAC users. The articles are free to read. Plain-language summaries of research are important for accessibility. Providing summaries in plain language helps make complex information easier to read. This helps to better understand and put the research into practice.
Summary of: Supporting effective alternative access for individuals with physical disabilities: state of the science, emerging technologies, and future research directions by Koester et al. (2025)
The Big Picture
If you can’t move your hands well enough to use a keyboard, how do you type? Kelli Johnsen uses her eyes. She looks at letters on a screen, and the computer tracks where she’s looking. Before ALS, she typed 100 words a minute with her fingers. Now she types with her eyes. She knows what makes a system work and what causes frustration.
The answer to that opening question depends on what you can move—your eyes, your head, a finger, even your breath. Alternative access methods are key. They determine whether someone can communicate.
Koester and a team of researchers, including Johnsen, wanted to know what was working and what wasn’t with alternative access methods. They didn’t run new experiments. They reviewed many studies by other researchers. They also spoke with experts at the Future of AAC Research Summit in May 2024.
What They Found
The team tackled three big questions.
First, does the access method matter? Yes, it does. Different methods lead to different performance. This can greatly impact performance and productivity.
Second, what is the best way to choose the “right” access method? A systematic approach to assessment is beneficial.
Third, what should researchers study next? This is the most important question. They argue that we need to focus on what users actually need rather than what engineers think is cool.
Speed Isn’t Everything, But It Matters
The researchers reviewed 57 studies. They measured typing speed—words per minute—because it’s easy to compare. But speed alone doesn’t tell the whole story. Comfort matters. So does whether a tool helps you reach your actual goals.
That said, the speed differences are dramatic. Speech recognition achieved a speed of about 15 words per minute, allowing users to communicate more effectively and potentially enhance their engagement in conversation, thereby improving communication. Standard keyboards with special tools—typing sticks, mouth sticks, hand splints—hit 10 to 13 words per minute. Touchscreens were about half that at 7 words per minute. On-screen keyboards controlled by eye gaze or cursor averaged 5 words per minute. Switch scanning, where you wait for the computer to highlight the right letter, was the slowest at 2 words per minute. People who know Morse code can beat that with two switches.
Brain-computer interfaces are still experimental. The systems you can buy crawl along at 0.7 words per minute. Lab versions hit 62 words per minute, but those aren’t available to the public yet.
Here’s the catch: these are averages. Some people using standard keyboards typed at a rate of only 1 word per minute. Others using eye gaze reached 15 words per minute. Your method doesn’t determine your speed. Every person is different. The effectiveness of this method relies heavily on the setup.
Set up Changes Everything
How you set up your tool can double your speed. People with spinal cord injuries type faster. They use head-controlled mice. They type twice as fast compared to those using chin-controlled trackballs. Modifying the duration of your gaze at an object before your eye tracker selects it can lead to a notable increase in speed.
Kelli Johnsen’s eye gaze system could work better with the right tweaks. The research backs her up. A study showed that careful adjustments boosted a scanning system by 136%. More than double the speed from better settings.
Combining Methods
Eye tracking has a problem. Users accidentally make selections with their eyes by gazing at items on the screen. Some researchers are fixing this by combining methods. Look at a letter with your eyes, but press a switch to actually select it. Or use your voice. Or move your head.
The team reviewed 34 studies on these combined approaches. Some combinations increased both speed and accuracy. But most studies happened in research labs, not real life. Only 5 included people who actually have physical disabilities. Therapists need to test these methods in real-world settings first. They can recommend them with certainty.
Finding What Works for You
A proper assessment involves a team—therapists, the person with a disability, and family members. They collect information on needs and goals. Then, they try different methods. Next, they choose the best option. They set it up with precision. They also provide training and offer ongoing support. When teams skip steps or rush through it, things go wrong. Studies show that poor assessments lead 70% of people to quit using their assistive technology.
Structured assessment tools help teams find key factors. They might miss them otherwise.
The researchers looked at 33 papers. They found that these assessment tools led to:
- more thorough assessments
- better teamwork
- more confident caregivers
- less-abandoned technology
Many professionals still trust their gut feelings. Some assessment tools are too complicated for busy therapists. The RERC on AAC is developing Access Navigator, a web app designed to simplify assessments.
Always Have a Backup
Technology fails. Batteries die. Settings change. You need a lite-tech backup.
Johnsen tells a story about a man with ALS who used an eye gaze device to communicate. New staff couldn’t figure out how to set it up. He had no backup—no communication board with letters he could point to. Without any way to communicate, he faced serious health problems. This isn’t about convenience. It’s about safety.
What Comes Next
People who use these technologies should help design and test them. Not as subjects that researchers study, but as partners. They know what works in daily life better than any lab researcher.
We also need more studies in actual homes, schools, and workplaces—not research labs. Researchers control and predict lab conditions. Real life isn’t controlled. A system that operates without issues in a lab can fail in everyday situations. A person might struggle due to fatigue, changes in lighting, or difficulty speaking in a noisy room.
The technology itself needs to get simpler and more reliable. Many systems require extensive setup and adjustments right now. That works fine when an expert is available. It falls apart when you don’t have an expert on hand. AI can help by using devices that learn individual patterns. These devices adapt without needing human help. But only if they’re designed with users, not for them.
Why It Matters
These tools aren’t luxuries. They help people with physical disabilities. They go to school, work, chat with friends, and join their communities. Today’s technology makes a difference. But we can do better.
The solution isn’t complicated. Get input from people with disabilities. Let them help design and test this technology. Focusing on the few people who use this technology can spark innovation that meets their needs well. Common sense, but it doesn’t happen often enough.
Citation:
Koester, H., Koch Fager, S., Gormley, J., Jakobs, E., Johnsen, K., & Brumberg, J. (2025). Supporting effective alternative access for individuals with physical disabilities: state of the science, emerging technologies, and future research directions. Augmentative and Alternative Communication, 41(3), 304–317.
Access the full article: https://doi.org/10.1080/07434618.2025.2499676
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