• Guidance

People with Communication Aids

Communication Aid

A system or device used by people who have difficulties with speech. It is one element in the broad field of Augmentative and Alternative Communication (AAC).

AAC

We use the term AAC to describe various alternative methods of communication when people have no speech or speech which is difficult to understand. Some AAC tools “add on” to verbal communication – simple methods such as pictures, gestures and pointing.

What to do if a person is admitted to hospital with a communication aid

Firstly, remember that the communication aid is a vital piece of equipment and it belongs to the person – it is not a toy. They need to be able to access it. Hospital staff must not lock it away for “safe keeping”. You don’t need to know how the aid works, but you do need to listen to what the person is saying via the aid.

Some communication aids speak with an electronic, computerised voice. Don’t be afraid to say that you can’t understand the electronic voice as it can take a bit of time to “tune in” to it. Sometimes it can be difficult to hear an electronic voice in a noisy environment. It is okay to:

  • Ask the person to repeat what they said
  • Ask them if you can read the text on the screen

Security issues

  • Check any equipment is clearly named in case it gets misplaced.
  • Inform the person in charge of the ward about the aid.
  • If an aid is being charged overnight, check who is responsible for it.

Problems

If the communication aid doesn’t work or if you have difficulties with it, contact the family/carer or the Speech and Language Therapy Department.

Guidance for Healthcare Staff

IIN ANY MEDICAL OR NURSING SETTING YOU MAY COME ACROSS SOMEONE WHOSE SPEECH IS DIFFICULT FOR YOU TO UNDERSTAND.

There might be times when you wonder whether the person is able to fully understand what you are saying.

This section is about people who have speech, language or communication difficulties due to a condition. This could be MND, MS, brain injury, stroke, cerebral palsy, learning disability, etc. Here are some tips and guidelines to make communication easier – for the person and for you.

NOTE. THESE SUGGESTIONS DO NOT CONTAIN SPECIFIC GUIDELINES FOR COMMUNICATING WITH PEOPLE WHO HAVE ENGLISH AS AN ADDITIONAL LANGUAGE, OR WHO ARE DEAF, ALTHOUGH YOU MAY FIND SOME OF THE GENERAL TIPS USEFUL FOR THESE PEOPLE. CONTACT YOUR LOCAL INTERPRETING SERVICES FOR SPECIFIC GUIDANCE AND HELP.

  • Conversations will take longer

    If possible allocate a double appointment to someone with communication difficulties; they will be more relaxed, you won’t feel rushed and you are more likely to gain a fuller case history, etc.

  • Ask questions one at a time

    Wait for them to reply to the first question before asking the next one or for clarification. This is harder than it seems.

  • Look at the person

    This might seem obvious, but you can gain a lot of additional information that might help you better understand what they are saying.

  • Speak to the person

    Even if they are accompanied by a relative/friend.

  • Don‘t pretend to understand if you don’t

    People can spot this immediately and find it insulting. Ask the person to repeat what they said, to say it in a different way, or if they can write it down. As a last resort ask their relative or carer to interpret.

  • Speak in short, clear sentences and avoid jargon

    If the person is able to read, write down key words on a piece of paper as you are speaking. Use gestures, pictures and props to demonstrate what you are saying, if appropriate. If you are talking about specific procedures, they may find photographs of the procedures easier to understand. It may be time-consuming to create the photographs, but they could be useful for others. Similarly, a simple diagram may explain a procedure much clearer than speech. You could also add specific gestures to what you are saying, such as pointing with your thumb to the upper arm to indicate an injection.

People with little or no speech

If the person has no speech, or speech that you find virtually impossible to understand, you might find these techniques helpful:

  • Ask questions where the person only has to answer “yes” or “no”
  • If this is too hard for them, ask how they usually indicate “yes” and “no”
  • Ask them: “Show me how you say YES. Show me how you say NO.”
  • Some techniques might be blinking once for ‘yes’ and twice for ‘no’, looking up for ‘yes’ and down for ‘no’, head nod/shake, thumbs up/down, pointing to ‘yes’/’no’ symbols, etc.

Ask the person if they have any alternative method to support their speech:

Can the person write?

If so, offer them a pen and paper to support their speech.

If the person can spell but is physically unable to write try using an alphabet chart.

If the person is unable to write, write the letters of the alphabet on a piece of paper and ask them to spell out what they are saying by pointing to the letters. If they can’t manage this, you can point to letters in sequence, asking them to indicate when you reach the desired letter. It helps to have a pen and paper handy to write down the letters as they are dictated.

Does the person have a communication aid?

If so, encourage them to use it.

Communication Breakdown

If the person appears to be trying to communicate something to you and you simply don’t understand, then try the following three questions:

Who are we talking about?

List the main people involved in the person’s care, slowly so that they can indicate when you have said the correct person.

Where are we talking about?

List the key events and places that the person has gone through, slowly so that they can indicate when you have said the correct place.

When are we talking about?

Is it something that happened today? Is it something that happened yesterday? Is it going to happen? Ensure that you don’t ask these all at the same time as it may not be clear which they are answering “yes” to.

Ask the person to use any alternative method to back-up their speech:

Getting started: Communication Without Technology

The Communication Partner

Communication is a two-way process. The “listener”, or communication partner, is as important as the “speaker”. The listener will need to develop a communication system with a person who has a number of disabilities.

The communication partner plays an important role because they interpret the reactions of the speaker to different experiences. Every movement, gesture and vocalisation has a meaning. Understanding all of these takes time, patience and a positive attitude towards the speaker’s ability to communicate.

Yes & No

Finding out how someone indicates “yes” and “no” might seem really basic, but it is very important.

It is very difficult to have a conversation with someone, to ask them a question, or even to find out basic information – for example, “Does it hurt here?” – if you cannot understand how they communicate “yes” and “no”.

If they are not able to speak, they will not be able to say “yes” or “no”. They also may find it difficult to nod or shake their head. You might have to ask them, “Show me how you say yes” and “Show me how you say no.”

Some examples of ways that people who are not able to speak indicate “yes” and “no” are:

  • looking up for “yes” and down for “no”
  • blinking once for “yes” and twice for “no”
  • a tight fist for “yes” or an open hand for “no”
  • pointing at the words “yes” and “no”’ printed on cards
  • moving their foot up for “yes” and keeping it still for “no”

FINDING A WAY TO SIGNAL YES AND NO RELIABLY THAT CAN BE UNDERSTOOD BY A RANGE OF PEOPLE CAN TAKE SOME TIME. HOWEVER, IT IS A GOOD STARTING POINT FOR FUTURE COMMUNICATION.

Signing and Gestures

Signing and gestures offer visual clues to what someone is saying. Some people with severe speech difficulties also struggle to understand and remember what people say to them. Signing and gesturing as well as speaking can give the listener additional clues that help them understand what the speaker is saying. Some people express themselves most effectively with body language, gestures and signing.

Using Objects

You can use objects to encourage people to choose; for example, holding up a bottle of cola and a bottle of orange offers them a choice of drink. You could also use objects to let them know what is going to happen; for example, you could show someone it’s time to go swimming by letting them feel their swimming costume before putting it in a bag. When we use objects this way, we sometimes call them “objects of reference”. It is essential to always use the same item to signify the same event. See the section on Using Objects of Reference for more details.

Using Photographs

Many people look at photographs and understand what they mean. Photographs can be used in exactly the same way as objects of reference. Showing some photographs of familiar objects around the house – a toy fruit, TV, family and friends – lets someone know what is going to happen, choose what they want to do, or tell you something. Try starting by showing them a choice of two photographs, then gradually increase the number of choices of photographs.

Ensure Communication Is Possible At All Times

It is important someone who has multiple disabilities has access to their means of communication at all times. Be helpful by keeping their communication method visible – for instance:

  • Today’s timetable displayed in three dimensions using objects of reference

  • Appropriate photographs or symbols on the wall in the canteen

  • Appropriate pictures around the sand pit or water tray

  • Pictures pinned to the wall above the bathroom sink, or suitable objects

Using Objects of Reference

If you are using objects of reference as a way to communicate, think about how a particular object will make sense to the person you are using it with.

  • Often we choose items because they have multisensory properties, such as scented soap to signify washing or a pair of riding gloves that smell of the horse to signify riding. An object may have a link to an activity, like a piece of seat belt/buckle to signify a trip in the car.

  • The object of reference must be relevant to the individual – two different people may have different objects of reference for the same toy or activity.

  • Avoid objects made of a material the person dislikes.

  • A child can build up a mental picture of an object of reference if they can handle it.

  • You can use a miniature version of an object, but be aware this choice may be more for your benefit than the person you are communicating with. If they have vision impairment, then a toy car bears little resemblance to the experience of going in a car – they cannot see that the toy car is a small version of a real car; it does not feel like one, sound like one, smell like one, or produce the sensation of riding in one.

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