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Background: More than 80% of people living with MND (plwMND) develop difficulties with their speech, affecting communication, self-identity and quality of life. Most plwMND eventually use an augmentative and alternative communication device (AAC) to communicate. Some AAC devices provide a synthesized voice for speech, however these voices are often viewed as impersonal and a factor in AAC acceptance. Voice banking creates an approximation of the person's own voice that can be used in AAC and is argued to go some way to preserve a person's identity when natural voice is lost, but there has been little supporting research. Aims: To understand what plwMND consider when deciding whether or not to bank their voice, what their expectations are, and the expectations of significant communication partners. Methods: Semi-structured interviews were undertaken with plwMND who had either decided to bank their voice or had decided not to. Thematic analysis was used to provide a qualitative analysis of the data. Procedures: Participants were an opportunistic sample of plwMND within England recruited via an open advert distributed by the MND Association (MNDA). Outcomes and Results: Twelve plwMND were interviewed with nine significant others. Nine participants had decided to bank their voice and three decided not to. The data suggest 'preserving identity' is the overarching motivation in decision making for voice banking. Participants who decided to voice bank considered it would help to maintain their identity and preserve their social and work networks. Participants deciding not to bank their voice 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. Conclusions and Implications: This research is the first study of its kind to examine the considerations for decision making around voice banking for plwMND. Preserving identity is central to decision making when considering whether or not to voice bank. However, the reality of using AAC and voice banking for communication is poorly understood. Professionals have a role to provide plwMND with more information about voice banking in the wider context of using AAC for communication. It may be that the process of voice banking itself is seen as a positive act for plwMND, independent of how it is used later. Further research with associated professionals and stakeholders is indicated.

Type Objectives Participant details (e.g. type of ALS age/sex and number), Technology used, Method Hird and Hennessey (2007) [48] Australia Primary Research, peer reviewed Therapy aimed at modifying a person's speech output to improve speech recognition software performance. 15 adults with dysarthria. Two had ALS. Type of ALS was not specified. One male age 46 and one female age. Power Secretary ASR technology was used 30 minutes of speech therapy treatment followed by 30 minutes of dictation. 15 sessions overall. Caves et al. (2007) [50] USA Conference Proceeding To improve ASR accuracy for plwALS with mild-severe dysarthria. 50 plwALS (21 male, 29 Female). No ALS type or age of participant reported. An adapted military training simulation ASR model was used. Participants read digits 0 to 9 and one hundred "zip codes".

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