Communication boards for adults

Who uses a communication board?

Adults use communication boards when talking is hard or impossible, for a few hours or for years. Families most often reach for one:

• After a stroke, when words are hard to find or say. Our guide to communication boards after a stroke covers the first weeks at home and in the hospital.
• With aphasia, a change in language after a brain injury such as a stroke. It can affect speaking, understanding, reading and writing. Aphasia itself does not affect intelligence. See our aphasia communication board guide.
• During a hospital stay, especially with a breathing tube, a mask or a dry, sore throat. See our free basic needs board and our one-page free hospital communication board.
• With conditions that affect speech over time, such as ALS or Parkinson's disease, often alongside other tools.
• When a person is simply too tired to talk, or can't hear well in a noisy room.

A communication board is a "low tech" tool: no batteries, no screen, no setup. Speech-language professionals call tools like this AAC (augmentative and alternative communication). Many people who use a speech app or device still keep a paper board as the backup that works in the shower, in bed and when the tablet is charging.

Types of communication boards

Most families start with one everyday needs board plus an alphabet page, then add topics.

What each board is built around

Which one fits a specific person is a question for the speech-language pathologist on the care team.

What to put on a communication board

Every board is personal, but a good first board follows the same pattern.

1. Put "yes", "no" and "I don't know" in the top row. They answer most questions, and a person should never have to hunt for them.
2. Add the everyday needs: drink, food, toilet, pain, tired, too hot, too cold, help.
3. Add people by name. "My family" is a start. A row of photos labeled with real names (Maria, Dad, Pastor Jim) is better.
4. Add feelings: happy, sad, frustrated, scared, okay.
5. Include an escape square such as "It's something else" or "Not on here." It tells you to keep guessing instead of giving up.
6. Add an alphabet page if the person could read and spell before, even if spelling is slow now.
7. Add their own words: the dog's name, the TV channel, the coffee order, the church, the grandkids.

How many squares? Fewer, bigger squares suit someone with low vision, a shaky hand or tiring attention: six large squares on a page is a fine start. Twenty squares fit a letter-size page at about 1.7 inches each. More than that usually means a second page, not smaller squares.

Pictures, words or both? Both. Put a clear picture and a short word or phrase in every square, one idea per square. Adults see clear, grown-up pictures, not cartoons.

How to print and set up a board

1. Print at "Actual size" (not "Fit to page") so the squares stay the size they were designed. US Letter and A4 both work.
2. Use cardstock, around 65 to 110 lb, so the page stands up on a table and survives a lot of pointing.
3. Laminate it or slide it into a heavy sheet protector. A laminated board wipes clean, which matters at mealtimes and in a hospital.
4. Print more than one. Keep a copy by the bed, one at the table and one in the car or the bag.
5. Put it where the hand already is: on a wheelchair tray, clipped to a bed rail, taped to the fridge at eye level, or on a clipboard.
6. Add hook and loop dots (Velcro is one brand) to the back of cut-out cards so you can swap words in and out.
7. Keep a dry-erase marker nearby to write a new word on the laminated sheet.

Print for tired or low-vision eyes. Squares of at least 1.5 inches, labels in large bold type, black on white. Color is a bonus, not a need: every picture should still make sense on a black and white printer.

Place the board on the side of the hand the person uses best. For someone who tires quickly, a bigger page propped at an angle (a cookbook stand works) means less reaching.

If pointing is hard

Not everyone can point. Two common workarounds:

• Partner-assisted scanning. Agree on a "yes" signal first (a nod, a blink, a thumbs up). Then you point to each row in turn, the person signals at the right row, and you go square by square along it. Say each word aloud as you point.
• Eye pointing. Hold the board up and watch where the person looks. Big squares spaced far apart make it easier to tell.

Check the signal with a few easy questions first, some with a yes answer and some with a no ("Is your name Maria?", "Is it nighttime?").

How to use a communication board together

1. Point as you talk. Touch "drink" while you say "Do you want a drink?" It shows how the board works without a lesson.
2. Ask one yes or no question at a time. "Are you cold?" is easier than "What's wrong?"
3. Wait. Count to ten silently. Finding a picture can take time.
4. Check back. "Water? Yes?" Point to the answer they gave, then say it aloud.
5. Write key words on paper as you speak, in large print.
6. Keep it adult. Talk to the person, not about them, and never quiz them on the pictures.
7. Use it yourself. When family members point to the board during ordinary talk, it becomes part of the house instead of a test.

If the person has a speech-language pathologist, bring the board to the next visit. They can suggest words, layout and access for that specific person.

Common mistakes

• Too many squares on one page. Split into topic pages instead.
• Only needs, no conversation. People want to say "I love you" and "turn on the game", not only "toilet".
• Childish pictures. Adults notice, and it matters.
• Hiding it in a drawer. A board nobody can reach doesn't get used.
• Guessing and moving on. Always check back before acting.

Communication board, app or device?

A paper board is cheap, quick to change and works anywhere. Apps and speech devices speak aloud and hold far more words. Many adults use both, and the speech-language pathologist on the care team can talk through device options.

Our printed boards are in the Doctor Carissa shop on Etsy (doctorcarissa.etsy.com): the Everyday Needs Picture Board for the fridge or the bedside, and the Yes, No, Alphabet and Numbers Board for spelling. The Everyday Needs Picture Board in English and Spanish has every label in both languages. The Everyday Communication Bundle puts six of our large-print printables in one file: the everyday needs and hospital boards, the yes, no and alphabet board, a feelings chart, the aphasia wallet card with its key-ring cards, and the conversation cards for reminiscing.

Guides and free printables

• Free printable

  Free feelings chart for adults

  A 12-square chart with pictures of adults, from yes and no to worried, frustrated and in pain.

• Free printable

  Free basic needs communication board

  A one-page bedside board with 20 large squares, an about me sign for above the bed, and a guide for staff.

• Guide

  Communication boards after a stroke

  Setting up a picture board in the hospital and at home in the first weeks after a stroke.

• Free printable

  Free aphasia wallet card

  A fold-over wallet card that says, in print, that the person has aphasia and needs time.

• Guide

  Aphasia communication boards

  Picture and word squares, written choices and conversation habits for talking with someone who has aphasia.

• Free printable

  Free hospital communication board

  One page, 16 large pictures in the words of a hospital room, from yes and no to nurse, bathroom and turn me.

Frequently asked questions

Where can I get a free printable communication board for adults?

Doctor Carissa's free large-print yes, no and alphabet board is a PDF in US Letter and A4, sent by email, and there is a free basic needs board for the bedside. The PPC Network and the University of North Carolina share free hospital boards, and the UK Stroke Association has a free Communication Picture Book.

Is a communication board the same as AAC?

A communication board is one kind of AAC. AAC covers every way of communicating besides speech, from gestures and writing to paper boards, apps and speech devices.

Can I make my own communication board?

Yes. Use a grid, one picture and one word per square, "yes" and "no" at the top, and the person's own names and places. Our Everyday Needs Picture Board includes a blank board you can type into before you print, and 20 spare picture cards to cut out.

Can someone use a communication board in the hospital?

Yes. Bring a laminated copy and put a sign above the bed so staff know to use it. Our free hospital and basic needs board is built for bedside use and comes with an about me sign.

What is the difference between a communication board and an alphabet board?

A communication board has pictures and words for whole ideas, such as drink or pain. An alphabet board has letters, so a person who can spell can point out any word, one letter at a time. Many families keep both, and our free yes, no and alphabet board has an alphabet page.