Some people who have communication difficulties also have physical difficulties and find it difficult to point to a book or chart or to handle communication cards. If they have good control over their eyes, they may be able to use an E-Tran frame.
The communication partner faces the user and holds the chart up between them. The user gazes at the letter, symbol, or word they want to say. Initially one symbol or word will be placed at each corner. As the user and communication partner become more skilled, symbols can be added in the middle of each side. The method can be developed using colour or number coding systems so that more items can be accessed.
Some very skilled people use a transparent letter board and spell out messages by eye gazing letter-by-letter. The communication partner requires skill to identify and remember which letter is being looked at. Some communication pairs are extremely fast and efficient communicators.