{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T15:50:22Z","timestamp":1768319422431,"version":"3.49.0"},"reference-count":64,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sclerosis"],"abstract":"<jats:p>Background: Amyotrophic lateral sclerosis (ALS) progressively impairs motor function, compromising speech and limiting communication. Augmentative and alternative communication (AAC) is essential to maintain autonomy, social participation, and quality of life for people with ALS (PALS). This review maps technological developments in AAC, from low-tech tools to advanced brain\u2013computer interface (BCI) systems. Methods: We conducted a scoping review following the PRISMA extension for scoping reviews. PubMed, Web of Science, SciELO, MEDLINE, and CINAHL were screened for studies published up to 31 August 2025. Peer-reviewed RCT, cohort, cross-sectional, and conference papers were included. Single-case studies of invasive BCI technology for ALS were also considered. Methodological quality was evaluated using JBI Critical Appraisal Tools. Results: Thirty-seven studies met inclusion criteria. High-tech AAC\u2014particularly eye-tracking systems and non-invasive BCIs\u2014were most frequently studied. Eye tracking showed high usability but was limited by fatigue, calibration demands, and ocular impairments. EMG- and EOG-based systems demonstrated promising accuracy and resilience to environmental factors, though evidence remains limited. Invasive BCIs showed the highest performance in late-stage ALS and locked-in syndrome, but with small samples and uncertain long-term feasibility. No studies focused exclusively on low-tech AAC interventions. Conclusions: AAC technologies, especially BCIs, EMG and eye-tracking systems, show promise in supporting autonomy in PALS. Implementation gaps persist, including limited attention to caregiver burden, healthcare provider training, and the real-world use of low-tech and hybrid AAC. Further research is needed to ensure that communication solutions are timely, accessible, and effective, and that they are tailored to functional status, daily needs, social participation, and interaction with the environment.<\/jats:p>","DOI":"10.3390\/sclerosis4010002","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T09:27:12Z","timestamp":1768296432000},"page":"2","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bridging Silence: A Scoping Review of Technological Advancements in Augmentative and Alternative Communication for Amyotrophic Lateral Sclerosis"],"prefix":"10.3390","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4423-7443","authenticated-orcid":false,"given":"Filipe","family":"Gon\u00e7alves","sequence":"first","affiliation":[{"name":"APELA\u2013Portuguese Association of Amyotrophic Lateral Sclerosis, 1900-221 Lisbon, Portugal"},{"name":"Faculty of Health Sciences, University of A Coru\u00f1a, Campus de Oza, 15006 A Coru\u00f1a, Spain"},{"name":"Nurse Oncology Research Unit, IPO Porto Research Center, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal"},{"name":"ADITGameS\u2013Association for the Development of Technological Innovation and Games in Health, 4490-010 P\u00f3voa de Varzim, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7251-5829","authenticated-orcid":false,"given":"Carla S.","family":"Fernandes","sequence":"additional","affiliation":[{"name":"APELA\u2013Portuguese Association of Amyotrophic Lateral Sclerosis, 1900-221 Lisbon, Portugal"},{"name":"ADITGameS\u2013Association for the Development of Technological Innovation and Games in Health, 4490-010 P\u00f3voa de Varzim, Portugal"},{"name":"Polytechnic Institute of Viana do Castelo, School of Health, 4900-347 Viana do Castelo, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4688-2291","authenticated-orcid":false,"given":"Margarida I.","family":"Teixeira","sequence":"additional","affiliation":[{"name":"APELA\u2013Portuguese Association of Amyotrophic Lateral Sclerosis, 1900-221 Lisbon, Portugal"},{"name":"Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"}]},{"given":"Cl\u00e1udia","family":"Melo","sequence":"additional","affiliation":[{"name":"APELA\u2013Portuguese Association of Amyotrophic Lateral Sclerosis, 1900-221 Lisbon, Portugal"}]},{"given":"C\u00e1tia","family":"Dias","sequence":"additional","affiliation":[{"name":"APELA\u2013Portuguese Association of Amyotrophic Lateral Sclerosis, 1900-221 Lisbon, Portugal"},{"name":"Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17071","DOI":"10.1038\/nrdp.2017.71","article-title":"Amyotrophic lateral sclerosis","volume":"3","author":"Hardiman","year":"2017","journal-title":"Nat. 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