Eye gaze board: free printable letter boards for ALS

Who it’s for

People who can move their eyes on purpose, but can’t speak or use their hands well enough to point: for example with ALS (also called MND), after a brainstem stroke, or in intensive care. It’s also for the partner on the other side of the board: family, caregivers and nurses. The partner-assisted scanning board on page 2 works for anyone who has one reliable yes signal, even if looking is tiring or unclear.

Before you start

• Yes and no. Agree on two clear signals: a blink for yes and eyes closed for no, or eyes up for yes. Write them on page 2, where every visitor can see them, so every partner uses the same ones.
• Glasses and light. Glasses on, if the person wears them; light on the person’s face, and no bright window behind you.
• The board. Card stock or laminated, so it stays flat. Cut out the center window, so you can watch the person’s eyes through it.
• Pen and paper, to write down each letter as it’s chosen.

How to use the eye gaze board, step by step

1. Hold the board up between you, about an arm’s length from the person’s face and at their eye level, with the letters facing them. Keep it at the same distance every time.
2. The person looks at the group with their letter and holds the look. Say what you saw: “Green group?” Wait for yes. If the answer is no, ask about the next most likely group.
3. Read that group’s letters out loud, one at a time, at a steady pace. “F… G… H…” The person signals yes at the right letter.
4. Write each letter down, and say the word so far: “F, A… Fa?”
5. Guess early, and check. “Fan? Do you want the fan?” A yes saves the rest of the word; a no costs only a moment.
6. Use group 6 to move on. Next word between words, start over after a mix-up, rest when they’re tired.

Partner-assisted scanning (page 2)

When looking at a group is too hard, the partner does the searching. Read the rows: “Row 1? Row 2?” When the person signals yes, read that row’s letters one at a time. The rows start with the letters used most in English (E, T, A, O, I, N), so most words take fewer steps. The person can listen with their eyes closed, which makes this work in a dark room or for someone with poor eyesight. For someone who doesn’t spell, use the partner-assisted scanning board with pictures instead.

When it’s hard going

Problem	Try this
You can’t tell which group they looked at	Hold the board a little further away or higher, and ask them to look a little longer. Say what you think you saw, and wait for yes.
Mix-ups in long words	Write every letter down, and read the word back after each letter.
The person tires quickly	Keep sessions short, ask yes-or-no questions where you can, and stop when they choose rest.
Visitors don’t know how it works	Write the signals and the steps on the back of the board, or on page 2.
You keep guessing wrong	Ask the person to spell the first two letters before you guess again.

Keep the board still while you read it: moving it makes the eyes harder to follow. Say every letter you think you saw. A wrong guess is quickly fixed; a silent mistake isn’t.

Keep the person in charge

Spelling with the eyes is slow, and it’s tempting to finish sentences. Ask before you guess the rest of a sentence, and accept no. Talk to the person, not about them, even when others are in the room. Some messages are private: ask whether they want visitors to step out.

What’s on the boards

Page 1, eye gaze board: group 1 A to E, group 2 F to J, group 3 K to O, group 4 P to T, group 5 U to Z, and group 6: yes, no, next word, start over, rest, thank you.

Page 2, partner scanning board: five rows of letters with the most common first, next word, oops, start over, end, the numbers 0 to 9, and 12 quick words:

• yes
• no
• maybe
• wait
• I’m tired
• thank you
• pain
• toilet
• a drink
• move me
• glasses
• my family

Printing tips

• Print page 1 on card stock, so it stays flat when you hold it up. Laminate it, then cut out the center window.
• Keep the scanning board at the bedside, with the signals written in, for nurses and visitors.
• For children and adults with cerebral palsy, read AAC and cerebral palsy: touch, switches and eye gaze.

When to look for more

A paper board is a reliable backup that never needs charging. A speech-language pathologist or an assistive technology team can help find the best way to communicate as needs change, including speech devices controlled by the eyes or by a switch. For a hospital stay, the ICU communication board and the hospital communication board add needs, pain and questions, and nurses and care staff can read how to communicate with nonverbal patients.