Tobii Dynavox

Non-speaking people with ALS, cerebral palsy, and autism mount Tobii Dynavox eye-gaze devices to their wheelchairs to generate speech when their own bodies cannot produce it.

ENABLE Model location

• Navigator-side Compensations → Use Assistive Technologies

What it is

Tobii Dynavox manufactures speech-generating devices (SGDs) and augmentative and alternative communication (AAC) software for people who cannot rely on natural speech. The company's flagship devices, the TD I-13 and TD I-16, combine a ruggedized touchscreen tablet with an integrated eye tracker, allowing users to compose and speak messages by moving only their eyes. Users mount these devices to wheelchairs, hospital beds, or desktop stands. The system tracks where the user is looking across a grid of symbols, words, or letters, then synthesizes speech from the composed message. For users whose eye control is also unreliable, the devices accept input via switches, head movement, or touch.¹

The primary user populations are people with ALS, cerebral palsy, Rett syndrome, spinal cord injury, and nonspeaking or minimally verbal autism. Approximately one-third of autistic people are minimally verbal or nonspeaking.² People with ALS who lose limb control first often use the devices for years; eye movement is typically the last voluntary motor channel to remain intact, which makes eye-gaze control the terminal communication option for many ALS patients.³

The core software platform, TD Snap, runs on Tobii Dynavox hardware and on iPads. The Snap + Core First vocabulary system organizes communication around a small set of high-frequency words -- "want," "go," "more," "stop" -- that form the backbone of everyday conversation, with pages of more specific vocabulary branching outward. Communicator 5, a text-based application, serves more literate users who compose full sentences rather than selecting from symbol grids. The PCEye product line attaches an eye tracker to a standard Windows computer, extending the same access technology to users who already own a computer but cannot operate a keyboard or mouse.⁴

Tobii Dynavox also produces software for environmental control -- users can operate smart home devices, television, and phones through the same gaze interface used for communication.¹ The company operates a dedicated insurance-navigation team that helps families and clinicians submit Medicare, Medicaid, and private insurance claims, since device costs of $10,000-$20,000 require third-party funding for most users.⁵

Tobii Dynavox is headquartered in Pittsburgh and is a subsidiary of Dynavox Group AB, a Swedish parent company. The company holds a dominant position in the global AAC hardware market.⁶

Why it matters

The cultural and medical default that produced the demand for Tobii Dynavox devices is centuries older than the company. European institutions from the sixteenth century onward classified people who could not produce intelligible speech as unable to think, unable to hold property, and unable to participate in legal proceedings. The equation of speech with intellect was encoded in law and medicine simultaneously: voicelessness meant incompetence. People with cerebral palsy, acquired brain injuries, and other conditions affecting the speech musculature were routinely institutionalized and labeled intellectually disabled based entirely on the absence of speech, not on any assessment of cognitive function.⁷ This arrangement was still functionally in force in mid-twentieth century North America, when children with cerebral palsy who could not speak were excluded from education, placed in institutions, and described in medical literature as uneducable.

The first systematic challenge to this inherited default came from rehabilitation professionals in the early 1970s, when Shirley McNaughton at the Ontario Crippled Children's Centre (now Bloorview MacMillan Centre, Toronto) adapted the Blissymbolics pictographic system for nonspeaking children with cerebral palsy. Charles Bliss had published Semantography in 1949 as a universal written language; McNaughton recognized that the symbols could represent ideas without requiring speech production. This was the founding insight of modern AAC: cognition and communication are separable, and people who cannot speak can demonstrate that they think.⁸ The first electronic speech-generating device, the EyeTyper, was developed in 1983 by Gary Kiliany and Mark Friedman at the Rehabilitation Institute of Pittsburgh, based on a meeting with a nonspeaking woman with cerebral palsy. Kiliany, Friedman, and Tilden Bennett formed Sentient Systems Technology, Inc. and commercialized the device. Sentient Systems released the first DynaVox product -- described as the first SGD with a touchscreen dynamic display -- in 1991.⁹ Tobii Technology, founded in Sweden in 2001 for research-market eye tracking, entered assistive technology in 2003 after founders met disability specialist Mick Donegan and launched the MyTobii D10 eye-gaze communication aid, recognizing that gaze-control technology could serve people with severe motor impairments.¹⁰ Tobii acquired DynaVox in 2014, combining the two largest companies in the AAC hardware market into the entity now known as Tobii Dynavox.⁹ In 2021, the combined company was spun off as an independent publicly traded entity on Nasdaq Stockholm and subsequently rebranded as Dynavox Group AB; the US brand Tobii Dynavox continues, while eye-tracking components are now supplied to Dynavox Group by the separately traded Tobii AB under a volume supply agreement extended in 2025.⁶¹⁰

The SGD market is structured by a reimbursement system that channels costs through Medicare, Medicaid, and private insurance rather than requiring out-of-pocket payment -- but this structure is fragile and has been used against the people it nominally serves. In early 2014, the Centers for Medicare and Medicaid Services simultaneously reclassified SGDs from purchased equipment to capped-rental equipment (cutting off devices after 13 months in hospice or nursing-home settings), required manufacturers to lock device software to prevent internet access, and increased claim rejection rates through three of four DME contractors. The combined effect was that ALS patients entering end-of-life care -- the precise moment they most needed communication -- had devices administratively removed.⁵¹¹ The ALS Association documented cases of patients who died unable to communicate final wishes after devices were reclaimed.⁵ Former New Orleans Saints player Steve Gleason, diagnosed with ALS in 2011, wrote directly to Congress and CMS and organized the advocacy campaign that produced the Steve Gleason Act of 2015, which reinstated devices as purchased DME, and the permanent Steve Gleason Enduring Voices Act in 2018.¹²¹³ When the reimbursement system contracted in 2014, private charity absorbed costs the federal program refused to carry: the Steve Gleason Foundation spent $1.5 million in six months purchasing approximately 100 devices for patients who lost coverage, at an average cost of $15,000 per unit, while annual Medicare spending on all SGD claims totaled approximately $20 million against a Medicare budget of roughly $600 billion.⁵¹¹ The reimbursement process typically takes one to six months even when eventually approved; families without resources to navigate the process or access charitable grants go without devices during that window.¹⁴

Race and class stratify who receives devices. African Americans with disabilities are approximately 60% less likely to use high-technology assistive devices than white Americans with disabilities in some datasets, including among veterans with similar functional impairments.¹⁵ The complexity of insurance navigation -- requiring a formal speech-language pathology evaluation, documented trial period, and persistence through appeals -- is itself a class-stratified burden; families with private SLPs, legal resources, and organizational connections navigate it more successfully. Rural families face a different structural problem: specialist SLPs capable of conducting AAC evaluations are concentrated in cities, and the underfunded school district is often the only institution a rural child with complex communication needs ever encounters.² Pediatricians routinely told families to "wait and see" whether speech emerged, delaying AAC access during developmental windows when early communication access matters most.¹⁶

Even among users who receive devices, AAC abandonment rates of 30 to 50 percent document a further failure: the device arrives but does not become a working communication tool.¹⁷¹⁸ Research identifies the primary drivers as negative attitudes among communication partners (family members, teachers, clinicians who believe they can understand the user's natural approximations and do not support device use), insufficient training for the user and their environment, vocabulary that does not contain words the person actually wants to say, and device maintenance failures when no one sustains the system as user needs change.¹⁸ Whether communication access materializes depends on the surrounding social environment -- its willingness to wait, train, and consistently engage with the device -- as much as on the hardware.

Children denied language access during the critical acquisition period develop permanent neurological differences: neuroimaging studies find structural brain changes based on the timing and quality of early language exposure.¹⁹ The literature on language deprivation in deaf children is structurally parallel to the situation of nonspeaking people without robust AAC, and the documented consequences are severe. Gallaudet University research funded by NIH found that adverse childhood communication experiences are significantly associated with increased risk for multiple chronic diseases in deaf adults, including heart conditions and depression.²⁰ For nonspeaking people specifically, communication deprivation denies the ability to report pain or medical symptoms, to refuse medical procedures, to report abuse, and to participate in healthcare decisions. These are not hypothetical losses. A 2024 scoping review in Augmentative and Alternative Communication found that functional communication is crucial for mental health and for coping with mental health problems, and that the mental health dimensions of AAC access have been systematically neglected in research relative to communicative outcomes.²¹ Nonspeaking people who cannot signal distress to caregivers also face elevated exposure to institutional abuse and mistreatment that is never reported, a risk documented in psychiatric and residential care settings.¹⁹

The state-of-the-art eye-gaze SGD achieves approximately 8 to 10 words per minute; natural conversational speech runs 125 to 185 words per minute.²² The gap means that even with the best available Tobii Dynavox hardware, an AAC user cannot participate in real-time conversation at parity with speaking partners. Communication partners frequently speak for the AAC user, finish their sentences, or cut conversations short because the rate gap exceeds their patience. This rate gap is a structural feature of the current technology frontier. It constrains the autonomy of even well-supported AAC users in ways that no device configuration currently eliminates. The right-to-repair movement in assistive technology directly implicates Tobii Dynavox's proprietary device architecture: when devices break, users depend entirely on the manufacturer for repair, and firmware and diagnostic tools are withheld from third-party technicians, creating repair deserts wherever the manufacturer lacks a service presence.²³ State right-to-repair laws passing in California, Minnesota, Colorado, and New York are beginning to address this structural dependence, but enforcement remains nascent.²³

Real-world examples

In the news

As they lay dying: Medicare rules rob voiceless ALS patients of the ability to communicate (2015)
-- Philip Moeller, PBS NewsHour

• In early 2014, Medicare simultaneously reclassified speech-generating devices to capped-rental status, mandated software locks, and increased claim-rejection rates -- cutting off ALS patients from communication devices during hospice care at the end of their lives. A Kentucky man with ALS, identified as Rick, was approved for a $12,000 eye-gaze device; when he entered home hospice, the device was reclaimed. The Steve Gleason Foundation purchased an identical unit four days later. The ALS Association described patients as "literally dying without voices." Tobii Dynavox president Tara Rudnicki stated: "People are literally dying without voices out there, while everybody sits here and argues." The PBS piece documented a systemic abandonment of the most dependent AAC users at the moment of greatest need.

In the news

Newly approved Steve Gleason Act secures funding for speech-generating devices for ALS patients (2015)
-- Maria Clark, NOLA.com / The Times-Picayune

• Former New Orleans Saints player Steve Gleason, diagnosed with ALS in 2011, used an SGD himself and organized a campaign that produced the Steve Gleason Act, signed by President Obama on July 29, 2015. The act reinstated SGDs as purchased Medicare DME and expanded coverage to accessories including eye-tracking hardware. The act required the advocacy labor of a nationally known athlete and millions of dollars in private foundation spending to restore a policy that was changed without public explanation. The permanent Steve Gleason Enduring Voices Act followed in the 2018 Bipartisan Budget Act, converting the temporary fix to a permanent one -- but only after sustained protest and rights assertion by the disability community.

In the news

Study Reveals Wide Gap in Awareness of AAC Devices for Children With Autism (2024)
-- Children's Hospital Los Angeles

• CHLA researchers documented that many pediatricians and providers do not feel knowledgeable enough to inform families about AAC options for autistic children, creating an awareness barrier upstream of any insurance or financial barrier. Families who do not receive referrals from the medical system are left to discover AAC devices through informal networks or advocacy organizations -- an endurance burden distributed unevenly across families by the depth of their social capital and healthcare connections.

In the news

The technology that gave Stephen Hawking a voice should be accessible to all who need it (2018)
-- Bronwyn Hemsley, The Conversation

• Following Stephen Hawking's death, commentators noted the stark contrast between the custom Intel-funded communication system Hawking used -- requiring millions in corporate investment and dedicated engineering over decades -- and the $15,000-$20,000 devices that ordinary ALS patients struggle to access through Medicare. Hawking's system was built at no charge by Intel and included dedicated software engineers available on call; most ALS patients receive devices through a reimbursement system that has administratively removed devices from dying patients. The disparity illustrates who bears the adaptation tax when communication technology is organized as a market product rather than public infrastructure.

• The Steve Gleason Foundation spent over $1.5 million in six months purchasing approximately 100 devices for ALS patients who lost Medicare coverage in 2014-2015, at an average device cost of approximately $15,000.⁵¹¹

• CommunicationFIRST hosted the first-ever federal research summit in May 2024 where nonspeaking people directly briefed senior federal officials on AAC research priorities. The journal Augmentative and Alternative Communication published 21 papers from the summit, with nearly all authored or co-authored by people who use AAC.²⁴

• In 2018, the Autistic Self Advocacy Network wrote directly to ASHA arguing that ASHA position statements violated the human rights of nonspeaking autistic people by restricting facilitated communication and rapid prompting method without soliciting input from the people who use those methods, and asserting that each nonspeaking person has the right to use the communication method that works best for them.²⁵

• In July 2025, CommunicationFIRST joined a 60-hour vigil alongside disability and caregiving organizations to oppose Medicaid cuts proposed in federal budget negotiations, directly connecting SGD access to the durability of the Medicaid coverage pipeline.²⁶

• African Americans with disabilities were approximately 60% less likely to use high-technology assistive devices than white Americans with disabilities in some datasets, including among veterans with comparable functional impairments, documenting racial stratification in AAC access.¹⁵

• Tobii Dynavox's dominant market position has been consolidated through acquisition. The 2014 combination of Tobii Technology and DynaVox Systems LLC merged the two largest companies in the global SGD market. Dynavox Group completed three acquisitions in 2025 -- Cenomy, RehaMedia in Germany, and SR Labs Healthcare in Italy -- continuing to absorb regional distributors and convert reseller relationships into wholly owned subsidiaries.⁶²⁷

What care sounds like (builder-side interventions)

Care at the design and development stages means building communication technology that meets users where their bodies are:

• "We're designing the eye-gaze calibration to work for users with nystagmus and inconsistent gaze control -- that's who needs this technology most."
• "The vocabulary system needs to include words the person actually wants to say. That means talking to users during development, before the page sets are finalized."
• "We test device durability for wheelchair-mounted use, because dropping and vibration are part of the daily environment for most of our users."
• "When a device breaks, the user loses their voice. Our repair turnaround standard has to reflect that: same-week service."
• "We train communication partners -- family members, teachers, aides -- alongside the user. A device sitting unused in a closet is a failure of our support model."

What neglect sounds like (builder-side interventions)

Neglect looks like systems that treat AAC devices as optional equipment or administrative items rather than essential communication infrastructure:

• "We'll reassign the device when the patient enters hospice -- they won't need it much longer anyway."
• "We lock the device to prevent misuse. If that means the user can't access other features, that's the trade-off."
• "The insurance evaluation takes three to six months. There's nothing we can do to expedite it."
• "We assumed the family would figure out the insurance process."
• "AAC devices are expensive. We can't include them in the standard school district AT budget."
• "Wait and see if speech develops before recommending a device. We don't want to interfere with natural speech development."
• "Doctors don't need to know about AAC. That's the speech pathologist's job."
• "If the device breaks, contact the manufacturer. We don't do AT repair here."

What compensation sounds like (navigator-side compensations)

Compensation describes the labor that nonspeaking people and their families perform when upstream care is absent:

• "My son qualified for a device two years ago but we're still waiting for insurance approval. In the meantime he's pointing and we're guessing."
• "I have to explain to every new aide, every substitute teacher, every new doctor how to talk to me, how to wait for my device, every single time. That never ends."
• "They took the device back when I entered hospice. My foundation had to buy me a new one. Four days without a voice."
• "I carry a low-tech backup board because the battery dies and then I have nothing. The board isn't enough but it's something."
• "My device only has the vocabulary my therapist chose. There are things I want to say that aren't on it. I work around it but I never say exactly what I mean."
• "I switch to typing on my phone when I'm somewhere that feels stigmatizing. The device draws stares. I'd rather be slower."
• "We filed three denials before the device was approved. I spent about forty hours on paperwork. Most families don't have that time."
• "The device broke and the manufacturer said four to six weeks for repair. I used a borrowed low-tech board and asked people to help me. Some things didn't get communicated at all."

---

All observations occur within the context of the speech-generating device and augmentative and alternative communication industry in the United States and Sweden, with primary documentation from U.S. Medicare policy, disability advocacy organizations, and clinical AAC research.

Footnotes

1. https://us.tobiidynavox.com/pages/td-i-series "TD I-Series -- Tobii Dynavox US" ↩ ↩²

2. https://pmc.ncbi.nlm.nih.gov/articles/PMC11197385/ "Comparing and contrasting barriers in AAC use in nonspeaking autism and complex communication needs -- Frontiers in Psychiatry (2024)" ↩ ↩²

3. https://www.asha.org/practice/reimbursement/medicare/sgd_policy/ "Medicare Coverage Policy on Speech-Generating Devices -- ASHA" ↩

4. https://us.tobiidynavox.com/pages/td-snap "TD Snap -- Tobii Dynavox US" ↩

5. https://www.pbs.org/newshour/economy/lay-dying-medicare-rules-rob-voiceless-als-patients-ability-communicate "As they lay dying: Medicare rules rob voiceless ALS patients of the ability to communicate -- PBS NewsHour (2015)" ↩ ↩² ↩³ ↩⁴ ↩⁵

6. https://dynavoxgroup.com/pages/our-history "Company History -- Dynavox Group" ↩ ↩² ↩³

7. https://en.wikipedia.org/wiki/Augmentative_and_alternative_communication "Augmentative and alternative communication -- Wikipedia" ↩

8. https://www.blissymbolics.org/index.php/about-blissymbolics "About Blissymbolics -- Blissymbolics Communication International" ↩

9. https://en.wikipedia.org/wiki/DynaVox "DynaVox -- Wikipedia" ↩ ↩²

10. https://corporate.tobii.com/about-us/history-of-tobii "Discover 20 years of innovation: The history of Tobii -- Tobii Corporate" ↩ ↩²

11. https://medicareadvocacy.org/until-there-is-a-cure-technology-is-the-cure/ "Until there is a cure, technology is the cure -- Center for Medicare Advocacy" ↩ ↩² ↩³

12. https://www.congress.gov/bill/114th-congress/house-bill/628/text "Steve Gleason Act of 2015 -- Congress.gov" ↩

13. https://www.nola.com/entertainment_life/health_fitness/article_66e4158c-1e5b-584c-b874-4f7ea1da994a.html "Newly approved Steve Gleason Act secures funding for speech-generating devices -- NOLA.com (2015)" ↩

14. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52469 "Speech Generating Devices (SGD) -- Policy Article A52469 -- CMS" ↩

15. https://pmc.ncbi.nlm.nih.gov/articles/PMC7985985 "Assistive Technology Access and Usage Barriers Among African Americans With Disabilities -- PMC" ↩ ↩²

16. https://www.chla.org/blog/experts/research-and-breakthroughs/study-reveals-wide-gap-awareness-aac-devices-children-autism "Study Reveals Wide Gap in Awareness of AAC Devices for Children With Autism -- CHLA" ↩

17. https://pubmed.ncbi.nlm.nih.gov/37210662/ "Rethinking device abandonment: a capability approach focused model -- Augmentative and Alternative Communication (2023)" ↩

18. https://pmc.ncbi.nlm.nih.gov/articles/PMC11197385/ "Comparing and contrasting barriers in AAC use in nonspeaking autism -- Frontiers in Psychiatry (2024)" ↩ ↩²

19. https://pmc.ncbi.nlm.nih.gov/articles/PMC5469702/ "Language Deprivation Syndrome: A Possible Neurodevelopmental Disorder with Sociocultural Origins -- PMC" ↩ ↩²

20. https://www.prweb.com/releases/gallaudet-university-research-study-finds-language-deprivation-communication-neglect-increase-deaf-children-s-risks-for-heart-conditions-depression-and-other-diseases-897353630.html "Gallaudet University Research Study Finds Language Deprivation Increases Risks -- PRWeb" ↩

21. https://www.tandfonline.com/doi/full/10.1080/07434618.2024.2434680 "Mental health and mental health problems among users of AAC: a scoping review -- Augmentative and Alternative Communication (2024)" ↩

22. https://pmc.ncbi.nlm.nih.gov/articles/PMC6515262/ "AAC Advances: A Review of Configurations for Individuals with a Speech Disability -- PMC" ↩

23. https://www.openassistivetech.org/right-to-repair-review/ "Right to repair review -- Open Assistive Tech" ↩ ↩²

24. https://communicationfirst.org/research "Future of AAC Research Summit and Research Priorities -- CommunicationFIRST" ↩

25. https://autisticadvocacy.org/2018/07/asan-letter-to-asha-on-the-right-to-communicate/ "ASAN Letter to ASHA On The Right To Communicate -- Autistic Self Advocacy Network" ↩

26. https://communicationfirst.org/we-take-care-of-our-own-protecting-medicaid/ "We Take Care of Our Own: Protecting Medicaid -- CommunicationFIRST (2025)" ↩

27. https://dynavoxgroup.com/blogs/press-releases/dynavox-group-to-acquire-sr-labs-healthcare-in-italy "Dynavox Group to acquire SR Labs Healthcare in Italy -- Dynavox Group" ↩