For a child with severe motor impairment and limited speech, which communication training is most appropriate?

• A. A combination of yes or no questions and pointing to pictures for communication
• B. Voice therapy for breathing
• C. Gradual phonation shaping
• D. Operating a computer with a voice synthesizer

Answer: (A)

When a child has severe motor impairment and limited speech, the first priority is to establish a reliable, easy way to express wants and needs without demanding extensive movement or vocalization. Using yes or no questions paired with pointing to pictures offers a practical form of AAC (augmentative and alternative communication). The child can indicate choices or needs by selecting a picture or signaling yes or no, while the adult uses questions to guide communication and confirm understanding. This approach builds a functional communication system quickly, uses minimal and accessible materials (like a picture board or simple symbols), and supports consistent responses across settings. It also leverages the child’s intact cognitive recognition to make communication meaningful and reduces frustration by giving them a clear way to participate in daily activities.

Other options focus more on improving voice production or on more complex computer-based communication, which can require greater motor control or vocal ability than the child currently has. Voice therapy or gradual phonation shaping aims at producing clearer speech, which may not be feasible or necessary for functional communication right away. Using a computer with a voice synthesizer can be powerful, but accessing and operating the device reliably often demands more precise motor control than the child can provide, especially at the start. Starting with simple yes/no prompts and picture pointing lays a solid foundation for communication that can later be expanded as skills and access tools evolve.