When ALS reaches the stage where hands, voice, and even head movement are no longer reliable, families face a communication crisis. The person they love is still fully conscious, still thinking, still feeling — but has almost no way to express any of it.
Blink communication is the answer at this stage. It is one of the oldest and most reliable methods in AAC — Stephen Hawking used a variant of it — and modern tools have made it accessible to any family with a phone.
How blink communication works
The principle is simple: voluntary blinking remains possible even at very late stages of ALS, because eyelid movement is controlled by a different neural pathway than the limb and respiratory muscles that ALS typically attacks first.
In Voxetu's blink mode, the phone's front camera watches the user's eyes continuously. When a blink is detected — identified by the eye closing and reopening — the app counts it and responds:
- 1 blink = YES
- 2 blinks = NO
- Held blink (2+ seconds) = HELP / SOS
The caregiver asks a yes/no question. The patient blinks the answer. The answer is spoken aloud by the app and logged in the caregiver dashboard with a timestamp.
A typical morning with blink communication
Here is how a family in Birmingham uses Voxetu's blink mode as part of their daily care routine:
6:35 AM — "Good morning David. Did you sleep well?" One blink — YES.
6:36 AM — "Are you in any pain?" One blink — YES. "Is it your shoulders?" Two blinks — NO. "Your back?" One blink — YES.
6:38 AM — The nurse repositions him and asks again. "Better?" One blink — YES.
6:40 AM — "Do you want your morning medication now?" One blink — YES.
Eight minutes. Six questions answered. No guessing. No frustration. And every response logged automatically in the dashboard so the family can see what happened overnight.
Setting up blink mode at home — step by step
| Step | What to do | Time needed |
|---|---|---|
| 1 | Open voxetu.com on a phone or tablet | 30 seconds |
| 2 | Sign up for a free account (Pro plan needed for blink mode) | 2 minutes |
| 3 | Open Blink Mode from the All Features menu | 10 seconds |
| 4 | Allow camera access when prompted | 5 seconds |
| 5 | Position the phone or tablet so the front camera faces the patient's eyes | 1 minute |
| 6 | Ask a yes/no question and wait for the blink response | Immediate |
Mounting the device
The phone or tablet needs to be stable and positioned so the front camera is roughly 30–60cm from the patient's face with eyes clearly in frame. Options that work well:
• A gooseneck phone holder clipped to the bed rail
• A tablet stand on a bedside table
• A wheelchair-mounted arm holder
• A caregiver simply holding the phone — works fine for short sessions
Adding carers to the dashboard
Once blink mode is set up, add family members and nurses to the care team. Every blink response is logged with the question context (if the caregiver types it), the time, and the date. The night shift can see what happened during the day. The family at a distance can see everything in real time.
When blink communication is not enough
Yes/no blink answering is powerful but limited — the patient can only respond to questions the caregiver thinks to ask. For more complex communication, Voxetu's blink mode also supports a scan-and-select keyboard: rows of letters highlight automatically, and a blink selects the active row, then the active letter. Slow, but allows the patient to initiate any message rather than only answering questions.
Set up blink communication for your family today
Voxetu works on any phone or tablet. No eye tracker needed. Free to start.
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