Access technologies for people with significant motor impairment with potential to impact speed and/or accuracy of communication: a scoping review

Individuals with significant communication and physical impairments often rely on augmentative and alternative communication (AAC) to facilitate independent communication across a range of communication partners and settings. Due to physical impairments, many individuals require alternate methods to access AAC systems, known as access technologies. While access technologies have advanced, they remain considerably slower than verbal communication. This scoping review explored recent advances in access technologies published between 2019 and 2024, focusing on technologies that facilitate communication speed and/or accuracy for individuals of any age with physical disabilities. Forty-six studies met inclusion criteria, covering a range of technologies such as brain-computer interfaces (BCIs), eye-tracking technology, and novel applications, such as a mixed reality AAC environment and multimodal access approaches (e.g., integrated eye-tracking with switch scanning, hybrid BCI eye-tracking). Despite technological progress, fewer than one-third of studies addressed the role of communication partners in setup and support, highlighting a gap in user-centred design. Findings are discussed in terms of practical applications and emerging directions for technology development. Implications for clinical practice and future research include the need for inclusive design, improved usability, and greater consideration of communication partner involvement in AAC access solutions.