Voice banking

Message banking is a process of directly recording individual words, phrases, sentences or personally meaningful sounds into a programme, thereby capturing the voice of an individual person with their own unique inflection and intonation.

Though unlike voice banking, a PSV is not created with this method of recording.

People often wish to record whole personal phrases, such as ‘I love you’ with their own voice, or routine daily requests that are unlikely to change. Calls to pets, laughter or other gestural sounds can also be recorded in this way.

People also message bank in languages not available in voice banking software.

The individual message banking recordings can be added to an AAC device, though playback is limited to only what has been recorded — they cannot be used for generating novel messages by spelling (Costello, 2020). People can record as many phrases as they wish for use on an AAC device.

Message bank recordings and a PSV can normally be utilised on the same AAC device, enabling more options for communication.

Message banking and voice banking should be discussed together and are complementary. Given the short time it may take to complete both, message banking and voice banking are frequently completed in parallel.

Speech and language therapists (SLTs) have an important role to both educate and to provide practical support regarding voice banking and message banking.

SLTs do not need to be experts in AAC to fulfil this role, as support is available once the need to use AAC arises. You also do not need to be a ‘techy’ person – the level of IT knowledge we all use in our day to day work is sufficient to support the voice banking process.

Voice banking and message banking are best carried out before there is significant change to speech quality.

Patients should be provided with enough information as early as possible to make their own decision whether to proceed.  In order to fully support this, speech and language therapy services should accept referrals for patients who do not yet have any difficulty with their speech or voice and may not yet have a formal diagnosis of MND or another condition.

Early referral is beneficial for allowing discussions around potential future options for AAC, and the availability of professionals to advise and support people regarding AAC, has been shown to improve AAC device uptake (Baxter, Enderby, Judge, & Evans, 2012).

It is important to confirm, at this stage, whether the person is likely to choose to use high tech AAC if their speech/voice alters. If they are only likely to choose low tech options with no voice output, voice banking is not an appropriate intervention.

Early input from the SLT is also important for forming a good working relationship with a patient and their family. This will help with all aspects of a condition as it progresses. It may also offer opportunities for discussion around other key areas, such as advance decision making, while communication remains ‘easier’.

It is important that the SLT sets expectations around voice banking and message banking. It is also worth noting that the PSV can never be an exact replica of a person’s voice and therefore some people may be disappointed and feel that the voice does not sound like them.

If available, SLTs should demonstrate their own PSV downloaded to an AAC device to practically demonstrate:

Many voice banking suppliers do not charge SLTs and other health and social care professionals to record their voice and download their PSV to AAC for demonstration purposes.

A discussion about options for voice banking and message banking can be sensitive. It may be difficult for patients to consider the possibility of a time when they may have no voice.

Some patients may not wish to consider voice banking while their natural voice is unaffected, and others may be frustrated that they had not been told early enough to be able to complete the process with their unaffected voice (Cave & Bloch, 2020).

Discussing voice banking and message banking in terms of ‘insurance’ –  in case voice may change in the future – is a helpful way to frame the conversation (Benson, 2015).

As ‘preservation of identity’ may be a major factor in deciding to voice bank (Cave & Bloch, 2020), the patient should be provided with information to make their own decision, even where their voice has already been affected by dysarthria.

Voice banking with dysarthria or dysphonia will result in a PSV with dysarthria or dysphonia – there will be no ‘correction’ of any impairment. Clinical experience indicates that this may still be acceptable and useful to people; conversely some people will record with unimpaired speech and voice yet not find the resulting PSV acceptable, and choose not to use it.

For those people with impaired speech or voice, the SLT could discuss using a ‘donor’ voice to create a PSV — possibly a friend or family member who sounds similar — as an alternative.

The SLT may also discuss digital legacy recording – the creation of video messages for family and friends. Digital legacy recording may be confused with voice banking (Cave & Bloch, 2020) and it is important to clarify that voice banking is for the purpose of use on an AAC device.  There are many ways to record a video message and Record me now (www.recordmenow.org) can be used as a framework for this.

We suggest that the SLT advises on the equipment needed, which may be a computer and a headset microphone, or a smartphone or tablet. Some services may loan equipment. The MND Association has an equipment loan service for plwMND (www.mndassociation.org).

As the voice banking process can often be completed in an hour or two, the SLT may train the patient to record independently or a significant other to support. They could provide speech and language therapy assistant support, or directly offer help themselves.

It is not essential for the SLT to be present for recordings. In some areas, the MND Association have trained Association Visitors in the process of voice and message banking, and may be able to provide assistance.

If the patient does eventually need to use AAC, the SLT can assist with downloading the voice onto the device. The assistive technology regional hubs may provide support for this if their AAC equipment is being provided.  Individual AAC software providers may also offer support with the download process into their software if needed.

There are costs associated with voice banking, but these are incurred almost always at the point of download to an AAC device. This means patients can normally record and create a PSV without delay or cost, however, funding will be needed to download the PSV to an AAC device if it becomes required.

The MND Association may provide funding for plwMND.

Clinical experience frequently reports positive feedback from patients who bank their voice, and from their significant others.

Choosing where and when to speak with a PSV is a highly personal decision and differs from person to person. Some choose to use their PSV only with specific people or situations, and then use a more generic synthetic voice at other times.

‘Preservation of identity’ is an overarching theme for plwMND deciding to voice bank or not (Cave & Bloch, 2020). Participants deciding to voice bank considered it would help to maintain their identity and preserve their social and work networks.

Participants deciding not to voice bank highlighted it could not replace their natural voice or preserve their identity.

However, few in either group showed an awareness of how a voice bank is used in AAC, and how communication using AAC is significantly different to natural speech (Cave & Bloch, 2020).

A PSV has been reported as saving the distress of significant others being unable to remember what their loved one sounded like, a kind of ‘vocal insurance’ in case voice is lost (Benson, 2015).

A PSV is argued to promote human interaction and social participation, enabling plwMND to function more effectively within their own families and social circles and allow them to contribute to wider society for longer through continued employment (Nathanson, 2016).

Significant others are usually supportive of their partner’s decision regarding voice banking and some felt a PSV could support their relationship as they try to manage the difficult times ahead (Cave & Bloch, 2020).

A PSV may be beneficial for AAC uptake as the behaviour and attitudes of communication partners towards AAC have been shown to  influence how and where AAC is used and ultimately how successful the provision of AAC may be (Scherer, Jutai, Fuhrer, Demers, & Deruyter, 2007).

Videoed interviews of two plwMND who were already using their banked voices (used for training of SLTs) indicated significant others may value a PSV more than plwMND themselves (Cave & Gleave, 2016).

However, no research has been identified that investigates the value of a PSV used in everyday communication (Linse, Aust, Joos, & Hermann, 2018). No quantitative data has been identified showing the difference between use of a PSV and a standard synthetic human voice available in many AAC devices  (Nathanson, 2016).

Jůzová reports that a significant improvement to quality of life was achieved by creating PSVs for several patients prior to laryngectomy. However, there is no indication of how they measured the change in quality of life or how the study could be replicated. Jůzová acknowledged that further research is required to show empirical evidence of any change in quality of life (Jůzová, Romportl, & Tihelka, 2015).

As voice banking is still a relatively new intervention, there remains a lack of evidence for the claimed benefits of it. However, there is significant and growing interest in voice banking, particularly within the MND community.

In 2018 the MND Association directly helped over 100 plwMND to voice bank. More than 600 registrations are forecast for 2020 (Cave & Bloch, 2020).

If you are an SLT interested in voice banking and think that it could benefit a service user, then we suggest these next steps:

Bank your own voice with at least one of the voice banking providers and download it onto an AAC device. This will make conversations much easier once you have something to demonstrate and can boost your confidence talking about the process. (At the time of writing) you may be able to bank your voice without charge from Acapela my-own-voice, Cereproc, ModelTalker and Voicekeeper. Other providers may help if requested.

Check whether you have the right equipment – you may need a computer and a headset with a microphone, or just a smartphone, depending on which provider you choose. You will also need an AAC device with software for demonstration. The MND Association can loan equipment to help people living with MND to bank their voice – an online loan request form is on their website.

Consider your client group and how you get referrals through for them. Is this early enough? Do you need to revisit your pathway and talk directly to referrers?

Almost every voice banking supplier allows the necessary recordings to be completed prior to charging for their service. This is particularly helpful if your patient’s voice is beginning to deteriorate. However, funding needs to be considered as far ahead as possible too, as voice banking is not usually paid for by the Specialist AAC hubs.

You may need to apply for funding from the local Clinical Commissioning Group (CCG) or a charity and this will take time. For plwMND the MND Association may be able to fund part or all of the cost. The MSA Trust may also be able to fund part or all of the cost for people living with Multiple System Atrophy.

Think about how to explain voice banking using the information you have read here. In our clinical experience, framing voice banking in terms of ‘insurance’ is very helpful.

Do not exclude service users who already have dysarthria from the opportunity of making their own decision about voice banking. Set out the facts and options, including the possibility of another person who sounds similar donating their voice.

Find one patient who may wish to try voice banking and work through it together. If your patient has MND, the MND Association can sometimes offer remote support to you and your patient through the voice banking process – contact communicationaids@mndassociation.org for more information.

Suppliers make various claims about their voice banking products though as with many commercial suppliers, if it sounds too good to be true it probably is.

It is helpful asking other professionals with voice banking experience what their recommendations are. @VoiceBankingMND on Twitter and Facebook is managed by richard.cave@nhs.net and followed by a large group of SLTs and other professionals supporting others to voicebank, and is a good forum to ask questions. Free voice banking and message banking training sessions are regularly arranged for SLT teams.

It can be a difficult task for service users to think about the most important sentences they wish to record for the future. If you have a patient who wishes to message bank, ask if they wish for significant others, friends and work colleagues to become involved too. Clinical experience has shown patients are not always aware of their own speech ‘isms’, phrases or words they say all the time. Other individuals’ perspectives will help your patient create a bigger volume of phrases to store.

Don’t be frightened to embrace the technology – this is a great tool in our SLT toolkit! Be ready to use it before a patient asks you – because someone will.

The following resources can be found on voice banking.

Read the following case studies on patients who have experience of voice banking: