open-standards/aac/aac-rs/tools/pagesets/DESIGN-adult.md

Adult conversation: a page set for adults whose talking has changed

adult.obz, built from phrases/sources/adult.yaml. For adults with acquired conditions: aphasia after a stroke or injury, ALS/MND, primary progressive aphasia (PPA), traumatic brain injury, Parkinson's. Shared conventions, extensions, translation and licensing: DESIGN-phrases-common.md.

Positioning. The app is for wellness, research and clinical-trial use; it is not a medical device. Nothing on these pages diagnoses, treats or predicts anything. The "About my talking" cards are things the person says about themselves, chosen by them (or someone they trust), never by the app; they describe what helps in conversation. The generator refuses any text that reads as a medical claim. The care pages speak aloud only: nothing is sent to anyone (the lesson of defect D2), and every care page says so to the partner.

What adults need, and what this set gives them

From the gap analysis (§2.11) and the published practice it cites:

Need	Here
Adult words, never childish	adult phrasing throughout ("I need the bathroom", "Please help me shave"); pictograms only, no cartoon symbols; photos of the person's own people and places
Yes / no / maybe / I don't know, always within reach	the always row: Back, Yes, No, I don't know, Wait, in the top row of every page
Rating scales	Rate it 0 to 10 (with "better / worse than before", "about the same", "it keeps changing"); five-step feelings and comfort scales
Pain	Pain: where (13 places, and "It hurts here. I'll show you."), What the pain is like (sharp, dull ache, burning, … comes and goes, worse when I move), and how bad (links to 0–10)
Explaining the condition to others	About my talking: cards for aphasia, ALS/MND, PPA, brain injury, Parkinson's, and In my own words to write
Repairing breakdowns	Fix a mix-up: "That's not what I meant", "Let me try another way", "Can you ask me yes/no questions?", "Almost. Keep guessing.", "Please don't finish my sentences", …
Word finding (anomia)	Help me find the word: say what kind of word it is (person, place, thing, something to do, food, time, number, feeling), then what it is like ("It starts with the letter …", "It sounds like …", "It's the opposite of …", "You use it for …")
Scripts	six Scripts, each with "Say the next line" (one press per line) and every line as its own cell
Life story and topics	My life and interests: family, work, homes, things I enjoy, travels, important days, my news — templates for the person's own photos and words
People by photo	People: 14 photo-and-name templates and "Where is …?"
ALS/MND care	Care needs → Move me (positioning), Breathing (suction, mask, machine, alarm), Personal care
Own voice	My own voice: 15 messages to record while the person can (message banking)
Fewer, larger choices	Simple page (3 × 4): for a tired day, or as the home page later in PPA

41 boards, 688 cells. reports/sets.md lists every board.

Layout

Every page is 4 rows × 5 columns: 20 targets, large enough for a tremor or a head pointer, and few enough for gaze. The always row (row 0) is the same on every page except the two homes: Back, Yes, No, I don't know, Wait — so the answers a partner asks for most are one press from anywhere, in the same place every time (motor stability, SPEC §3), and a switch or gaze user always has a way back on the page itself (defect D1). The home page keeps Yes / No / I don't know / Wait in the same four places and puts "About my talking" where Back is elsewhere.

Rows 1–3 hold the page's 15 messages or links. Colour says what a cell is for, never only colour: answers yellow, repairs orange, pain and body pink, comfort light blue, feelings rose, questions lilac, chat green, scripts violet, life story lime, care teal, own voice amber; links are the colour of where they go. Text is black on pale backgrounds throughout.

The rating scale runs from white (0) to deep amber (10), black text, so it reads in greyscale and to people who do not see red and green apart. 0 and 10 carry their anchors in their labels ("0 none", "10 the most") and say them in full ("10 out of 10: the most there could be").

Messages, not words

Almost every cell says a whole message ("My throat hurts.", "Please wipe my mouth."). For aphasia and PPA a whole message in one press is what makes the page usable; for ALS it saves effort. The label is the message itself, so a reader sees exactly what will be said. Where a message is long (the condition cards), the label is the short form ("I have aphasia") and the cell says the whole card:

"I have aphasia. I know what I want to say; I have trouble finding the words. Please give me time."

About my talking

Five cards and a blank one. Each card is the person explaining themselves, in the first person, followed by what helps in conversation — the advice that aphasia and ALS organisations give partners, put in the person's own mouth:

• Aphasia: "Aphasia affects language, not intelligence." / "Reading and writing can be hard for me too." / "I may say the wrong word. Please check with me." / "Please don't pretend to understand. It's OK to tell me you didn't get it." / slower speech, shorter sentences, key words written down, gestures and pictures, yes/no questions.
• ALS / MND: "It affects my muscles, including the ones I use to speak." / "I can hear and understand you." / "Talking tires me." / "I choose with my eyes, so please be patient." / "Please read my screen if you can't hear it." / "If this app isn't working, please use my letter board." / "Some of these messages are in my own voice."
• Primary progressive aphasia: "Finding and understanding words is getting harder for me over time." / "I'm still me." / "Please show me as well as tell me." / "If I get stuck, please give me two choices." / "Please don't correct every word I say."
• Brain injury: short conversations, somewhere quieter, one question at a time, reminders of the topic, important things written down, "I may get frustrated. It's not about you."
• Parkinson's: "My face may not show how I feel." / "Please don't rush me." / "Please tell me if you can't hear me." / "My voice changes during the day." / "Please face me when you talk."
• In my own words: "I have …", "It affects …", "What helps me: …", "Please …", "Please don't …" to fill in.

Each card ends with "This started in …" (to fill in or leave out), "Please give me time to answer" and "Please talk to me as an adult". The person chooses which statements are true for them: a card is a template, and any cell can be hidden (Track B) or rewritten.

Scripts

Six situations: Introducing myself, At the doctor's, Ordering at a café, Starting a phone call, At the pharmacy, Asking for help in a store. Each script page has:

• Say the next line (top left of the content): a sequence cell (ext_aurasense_sequence) whose lines are the script's opening cells, in order ("@1,1" … in the source, "at": [1, 1] in the package: the line is that cell, so editing the cell edits the script, and a recording on the cell is what the line plays). One press per line; after 30 idle minutes it starts again.
• every line as its own cell, to say again, or out of turn;
• the responses the situation needs ("It's getting worse.", "No milk, thanks.", "Please don't hang up.", "Can you hear me?").

Personal facts are fill-in cells ("Hello, my name is …", "I'm here because …", "I take these medicines: …", "I'd like a coffee, please." with "Change to your usual order"), marked ext_aurasense_fill_in so Edit mode can list them. The phone script opens with "I use a speech app, so please give me time to answer." and "Please don't hang up." — the two lines that keep a call from being cut off.

Without the sequence extension, "Say the next line" says the first line; every line is still a cell.

Life story and people

My life and interests has seven topic pages; People has fourteen. Their cells are templates (fill: {photo, words, hint}): "This is my partner, …" with the hint "Add a photo and their name". A person with aphasia or PPA often recognises a photo where a word fails; a partner who sees "My work" with a photo of a workshop has a conversation to start. Track B adds the photo and the words; until then the cells say their template words and show their labels.

"My news" is a sequence too ("Guess what?" → "This week I …" → "I saw …" → "It was great!"), meant to be rewritten often, so there is always something new to tell.

Care, breathing and positioning (ALS/MND and anyone who needs care)

Care needs (bathroom, drink, medicine, glasses, hearing aid, call the nurse or family, "I need help now!", stay with me, check on me, lights), with three pages behind it:

• Move me: up the bed, onto the left / right side / back, raise or lower the head of the bed, sit up, lie down, fix my pillow, move my arm / leg, "A little more.", "Stop. That's good.", "That's better, thank you."
• Breathing: "I need suction.", "I'm short of breath.", "Please help me cough.", "There's something in my throat.", mask checks (leaking, on, off for a moment), "Please check my breathing machine.", "The alarm is going off.", "Please call the nurse now.", "I need a break from talking."
• Personal care: washing, teeth, hair, wiping mouth and eyes, an itch, shower, changing, shaving, glasses, dressing, a blanket, the door, privacy, "Please be gentle."

These pages speak aloud; nothing is sent to anyone, and the Breathing page says that it "does not replace alarms or monitoring". A real alert, through a channel the person sets up, is separate work (the report's D2 item). There is deliberately no cell to turn a breathing machine off.

My own voice holds fifteen messages to record in the person's own voice while they can (message banking: Team Gleason's guidance, report §2.11): "Hello, it's me.", "I love you.", "Thank you.", "Good morning.", "Good night.", "That's funny!", "You're kidding!", "Oh no!", "Come here, please.", "I'm proud of you.", and short ones whose tone matters most — "Yes!", "No!", "Please.", "Wait!", "Help!". Each is fill: {recording: true}; Track B's message banking puts the recording on the cell, and the app plays it instead of the synthetic voice. The words are a start: the person should replace them with the things they say most.

A staged plan for primary progressive aphasia (guidance for partners)

PPA changes over time, so the support should change with it, chosen with the person and reviewed with them regularly. This follows the staging in Fried-Oken (2008, AAC treatment for primary progressive aphasia, OHSU): start early, involve partners, and move to simpler supports as needed. It is guidance for adapting communication supports. It is not medical advice, and it does not diagnose, treat or slow anything.

Early: words are harder to find; conversation mostly works.

• Use the whole set. Lean on Help me find the word, Fix a mix-up and the Scripts for situations that matter.
• Fill in My life and interests and People now, with the person choosing the photos and the words, while they can.
• Record My own voice now.
• Use the app in easy, everyday conversations, so it is familiar before it is needed.
• Partners: wait; offer two choices; write key words; don't correct every word.

Middle: fewer words come; long sentences are harder to follow.

• Make Simple page the home page (Settings → Home board), or hide the pages that are not used (Track B: hidden in place, never moved, SPEC §3).
• Rely on photos, yes/no, the 0–10 scale and the always row.
• Keep every cell where it is: moving words breaks the motor memory the person still has.
• Partners: short sentences, one question at a time, yes/no questions, show as well as tell.

Later: speaking is very limited.

• Simple page as home; photo choices; yes and no.
• Partners lead conversations from the life story pages and photos.
• Keep printed copies of the Simple page and the People page by the bed and chair (the printing track), for when a screen isn't to hand.

At every stage: the person chooses, as far as they can; changes are made with them, not to them; and nothing is taken away that they still use.

What this set does not copy

Commercial aphasia sets (TD Snap Aphasia, Lingraphica, Grid's Aphasia Duo, TouchChat's Communication Journey) are proprietary; none of their words, layouts, page names or wording is used, and none is named on a board. The needs above are public practice (report §2.11): adult vocabulary, rating scales, repair, scripts, life story, message banking. The always-row layout, the page names, the messages, the cards and the scripts were written for this project.

Symbols

Pictograms only (Mulberry, then OpenMoji); no Bliss and no child-styled symbols. 28 adult concepts have no symbol in the app's index yet, among them throat, neck, chest, shoulder, arm, leg, hand, suction, frustrated, bored, lonely, proud, embarrassed, comfortable, appointment, person, place, thing, number, thank you, pet and holiday. Those cells show their words (adults read them), and photos can be added. The full list: phrases/reports/symbols.md.

Not in this set

• A whiteboard (write or draw a note): out of scope; it needs a drawing surface in the app.
• A keyboard and alphabet board for spelling: the keyboard track (aac/keyboard); the ALS card's "please use my letter board" points to a printed one.
• A calendar: needs dates from the device; later.