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What happens when we can’t communicate?

Managing difficult communication challenges

Alicia Mould

Specialist Speech and Language Therapist

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Aims

• To improve the experience of health care for people with communication difficulties – To increase awareness of communication

– To gain knowledge of different communication disorders

– To understand the role of the speech & language therapist

– To improve skills in communicating with adults with communication disorders

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What is communication used for?

– Meet needs (buy a bus ticket)

– Social interaction (smile)

– Self expression/maintaining identity

– Connecting with others

– Seeking/giving information (listen to the news)

– Entertainment (listen to the radio/T.V)

– Seeking/giving consent

– What is conversation like when you have aphasia?

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Methods of communication

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Possible Causes of a Communication Disorder

• Stroke/Cardio Vascular Accident (CVA)

• Traumatic Brain Injury • Dementia

• Progressive Neurological Conditions e.g. Parkinson’s Disease, Multiple Sclerosis, Motor Neurone Disease.

• Head and Neck Cancer/Laryngectomy

• Tracheostomy

• Other causes include: – Mental Health, Infections, High fevers.

• Speech is a mechanical /physical

process

• Language is a system of sounds, words

and sentences

• Communication is a social activity

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Types of communication disorders

Cognitive-communication

difficulties • Memory

• Attention

• Motivation

• Planning

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Aphasia • LANGUAGE disorder

• Problems with:

• Getting messages IN:

• Understanding

• Reading

• Getting messages OUT:

• Speaking

• Writing

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Dyspraxia

• A disorder of PLANNED movement

• People have difficulty saying what they are consciously thinking about saying

• Speech errors e.g. hospital hopistal.

• Speakers are often aware of their errors and try again

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Dysarthria • A motor SPEECH disorder

• May be in addition to dysphasia and

/ or dyspraxia or it may occur in isolation.

• Affects different aspects of speech physiology; – Respiration – Phonation – Articulation – Resonance – Voice quality/pitch

• The presence of dysarthria can sometimes make it difficult to establish if there is any aphasia.

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Dysphonia

• A VOICE disorder

• May present as breathiness, hoarseness, low volume, abnormal pitch or total loss of voice.

• May co-occur with Dysarthria

• Disorders which commonly effect voice are: Parkinson's Disease, Multiple Sclerosis, CVA, Cancer.

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The role of the SLT

• To find out the extent, type and severity of disordered communication

• To provide a communication diagnosis

• Inform and advise MDT members

• To provide information and support for patients and family/carers

• Identify strengths and provide strategies for ways to help them communicate.

• To make recommendations for therapy

Access to communication

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Communication is a two way process

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speaker listener

message

reply

Patient’s experiences

• Video examples

• Dealing with problems

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Preparation: • Reduce background noise and distractions

• Check SLT reports and any personalised advice

• Ensure you have the right ‘tools’ ready (e.g. pen and paper/pictures)

• Check hearing aids/glasses

• May be helpful to plan out what you need to ask (how can you simplify your language if needed)

• Check their communication aid is available and working if they use one

• Is now a good time?

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Supporting understanding

• Give extra time

• Use short sentences and familiar words (avoid medical jargon)

• Establish a reliable yes/no

• Repeat/rephrase your message as needed

• One idea at a time

• Use gestures/written words and pictures to get your message across

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Supporting expression

• TIME

• Offer a pen and paper to draw/write down a word

• Ask closed questions

• Check with them on what you think you have understood

• Don’t pretend you have understood if you haven’t

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• Acknowledge frustration

• Encourage use of gesture/writing/pictures/communication aids

• If they can’t find a word encourage them to talk around the word

• If speech is unclear encourage the person to use a LOUD voice and speak in short sentences

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If conversation breaks down

• Check what you have understood so far

• Try writing it down or drawing

• If it still fails, agree with the person whether to leave it or keep trying

• Acknowledge frustration

• Use humour

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AAC Grid 2

Allora 2

Phone apps

AAC

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Boogie board Communication book

E-tran frame Hospital communication passport

OVER TO YOU…

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What are you doing at the weekend?

Answer the question WITHOUT speaking or writing words.

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Conclusion

• Communication is a two way process

• We can enable or disable patients

• Be resourceful in facilitating communication

• If unsure contact the speech and language therapist for advice

• SALT : RHH/WPH on x12533

NGH on x15068

Community x52565

Useful links • www.communicationpeople.co.uk

(Hospital Communication Passport)

• http://nww.sth.nhs.uk/NHS/Nursing/Deme

ntiaManagement/ (All About Me)

• https://www.stroke.org.uk/what-is-

stroke/what-is-aphasia/communication-

tools#Communication aids 26