1 Say What.. Working with people with complex communication needs October 2014
2 Todays presentation Communication Complex Communication needs Behaviour AAC Strategies Key Word Sign
3 Role of the Speech Pathologist Assess communication skills Develop and maintain communication systems and strategies Prescribe electronic communication devices Train users, family and significant others in communication systems Consult with services regarding inclusion Assess eating / drinking skills and then develop appropriate mealtime plans Assess and provide information support for saliva control Refer for additional services e.g. dental, hearing Collaborate with other specialist services (OT, Physio, Psychology)
4 What is communication? A complex activity Exchanging information, feelings, thoughts, ideas and opinions Can be verbal and/or non-verbal The Purposes of Communication (Light, 1988) Expressing needs/wants Information transfer Social closeness (relationships) Social etiquette (social conventions of politeness)
5 Communication has two main components: Receptive Communication Receiving and understanding a message Expressive Communication Giving a message
6 How we communicate?
7 Activity Communication Breakdown 1 volunteer How did you feel? Audience How did you feel? Would have made it easier?
8 Complex Communication Needs When a person s communication is temporarily or permanently inadequate for meeting their communication needs they are considered to have complex communication needs. They have difficulty communicating using speech alone. They have little or no speech OR Speech that is hard to understand
9 People may have communication difficulties associated with: Developmental delay Intellectual disabilities Autism spectrum disorders Physical disabilities Sensory impairments Specific language disorders
10 Communication and Behaviour Sometimes a person may communicate in a way that is not easily understood by others. They may use certain behaviours to communicate. These behaviours, if complex, can be perceived as behaviours of concern. Remember: All behaviour serves a function for that individual. It is not always easy to work out what the message is.
11 Behaviours of Concern Behaviour of such intensity, frequency and duration that the physical safety of the person or others is placed, or is likely to be placed, in serious jeopardy, or behaviour which is likely to seriously limit the use of, or result in the person being denied access to ordinary community facilities, services and experiences. Emerson 1995
12 Possible Functions of Behaviour To gain social interaction To escape or avoid demands To gain access to preferred activities or tangible objects To experience sensory feedback (e.g. hand flapping, eye poking) To gain power and control over own life To reduce arousal and anxiety
13 The Communication Continuum Understanding a person s abilities assists us to: Provide information in a way that is meaningful to them so that they can make sense of the world Provide them with opportunities to communicate There are different stages of communication. There are key characteristics at each stage that assist us to determine a person s communication level. A Speech Pathologist can also provide you with more detailed information about a person s ability to understand and communicate.
14 Key Stages of Communication: Unintentional Intentional Informal Symbolic Basic Established
15 Unintentional Communication At this stage people can may: React to familiar people, objects or events Be aware of familiar routines e.g. Move a body part to assist with dressing Need others to interpret what their communication means Be unable to speak, sign or recognise pictures for communication At this stage people can not: Use conventional communication methods Understand people can be used to meet needs Understand spoken language.
16 Intentional Informal Communication At this stage people can: Understand that other people can be used to meet their needs and wants Use some simple gestures such as pointing, showing or giving Respond to simple spoken or signed requests such as give me, sit down Choose between 2 4 preferred objects when they are presented Not recognize photos, pictures, line drawings or print
17 Symbolic Basic Communication At this stage people can: Understand simple sentences Follow simple one-step directions Use approximately five single words, signs or gestures for basic communication Relate some photographs/pictures to real objects or people Imitate or attempt to imitate most words and gestures
18 Symbolic Established Communication At this stage people may: Communicate using about 50 single words, signs or pictures Use photos/pictures/signs to initiate and make choices Think through a solution to a simple problem Respond to simple two-step instructions out of their routine Understand simple conversation
19 What level is this person communicating at? 1. This person walks over to you and hands you a set of keys and then looks at you and walks away. There is no verbal communication. 2. This person uses his voice in different ways. The mother tells you when the person is not well he will make no vocalisations at all. If the person is happy or content he will change the tones in his voice. He does this but does not look at you. 3. This person brings you a photo of KFC and gives it to you and looks at you.
20 So what can you do? Once we know a person s abilities we can then focus on how to best support them. For those who can not communicate with speech alone, augmentative and alternative communication is an option to be considered in an attempt to enhance their opportunities to communicate.
21 Break KWS Australia Basic Workshop 2010
22 A shared responsibility A communication disability does not just belong to the individual. It belongs to the entire environment of which the person is the focal point Sandwell Communication Aids Centre United Kingdom
23 Communication Strategies Augmentative and Alternative Communication (AAC): A group of communication strategies that a person uses as an alternative or to supplement their speech. Augmentative communication supplements speech. It includes manual sign, gestures, use of pictures, spelling, word/phrase boards, electronic devices. Alternative communication is a means of communication that is used instead of speech. It includes manual sign, gestures, use of pictures, spelling, word/phrase boards, electronic devices.
24 Why is AAC used? By providing an effective way for someone to communicate, AAC increases the person s opportunity for social relationships, community involvement, education, employment and independence (Communication Resource Centre, Scope, 2012).
25 AAC uses To increase comprehension As an alternative, main means of communication Temporary or permanent As a supplement to speech e.g. dysarthria Until speech develops e.g. developmental delay
26 AAC - Augmentative and Alternative Communication Aided & Unaided (uses object or equipment) (person s body only, no equipment)
27 Unaided Types of AAC modes Aided body movements facial expression natural gesture (pointing) idiosyncratic signals mime Key Word Sign Signed English Auslan real objects object symbols logos/photos pictures pictographs ( e.g. PCS, Widgit, COMPIC) (other symbols e.g. Minspeak) whole words spelling
28 Aided AAC High Tech Low Tech Considerations Cognition Language ability Mobility and access
29 Picture Symbols It is important to identify what level the person is for object to picture association Photos are the easiest to understand Line drawings vary in complexity Written words are the most complex See Appendix One for the symbol choices
30 Personal Communication Dictionary Who? Why?
31 Timetable Who? Why?
32 Chat Book Who? Why?
33 Key Word Sign
34 What is Key Word Sign? a simplified form of manual signing. designed for use by and with people who have communication difficulties uses the same signs as the Deaf community. different to deaf sign in that: - speech is used with signs - only the key words in a message are signed
35 Who uses Key Word Sign (KWS)? Children and adults with communication needs who have difficulties with attention comprehension intelligibility developing speech AND the people who interact with them!
36 Why do YOU need to learn Key Word Signing? A communication disability does not just belong to the individual. It belongs to the entire environment of which the individual is the focal point Sandwell - Communication Aids Centre, UK
37 Principles of Key Word Signing Always use speech together with the sign Speak in normal, grammatical sentences Sign only the key words in the sentence Use facial expression and body language Use directionality and placement Teach signs that are relevant KWS Australia Basic Workshop 2010
38 History of Key Word Sign Used internationally with people with communication difficulties since 1970 s uses signs of the deaf community in the host country Introduced in Australia (as Makaton) in early 1980s Margaret Walker, Kathy Johnston, Tony Cornforth (originally used with adults) Changed to Key Word Sign in 2010 developed an Australian vocabulary of KWS
39 The Power Of Natural Gesture Natural gesture is a useful means of communication Specific information is difficult to convey with natural gesture alone So, Key Word Signing is used with natural gestures
40 Natural Gesture Put Go Goodbye Swim Open Come Hot Dog Choose Give Cold Cut Look Stop Wait Paste Stand up Here Run Draw Sit There Eat Ice cream I / me Baby Drink Write You Car Up Throw We Wash Down Hat (sign names) Hello Good Turn on/off 33/40 = Most frequently occurring word list (Marvin, Beukelman & Bilyeu, 1994)
41 Finger Spelling
42 Who to use KWS with (see handout) For understanding For communication Pre or Unintentional Yes gesture, touch, basic sign No Intentional but not Symbolic Yes gesture, touch, basic sign use objects Early symbolic Yes provides Yes: basic (5 model too, gesture signs); established phrases (50 +, 2 sign comb.) Symbolic Yes - ++ Yes if supported KWS Australia Basic Workshop 2010 No may point, Hard of Hearing Yes - ++ Depends on cognition Vis. Dis Yes - ++ Depends on cognition
43 Who can benefit from KWS? Not everyone can learn to use signing to get their message across (i.e. for expressive communication). But EVERYONE can benefit from signing to help their UNDERSTANDING! Remember: NO ONE IS HARMED BY USE OF SIGNING, and you never know what skills a person may develop in the future. So keep on signing!
44 Responsibilities We all share the responsibility for: Valuing each person s unique way of communicating Understanding how each person communicates Being responsive to people s communication Allowing people the opportunity to have their say Learning how to communicate more effectively with people with complex communication needs Assisting people to participate in social interactions and activities and be included in the community
45 Role of the Communication Partner Acknowledge and respond to all communication attempts Provide opportunities for the person to communicate, make choices and socialise Be patient and allow time for people to respond Let the person know if a response is required show me, tell me Understand and use strategies that help the person understand Understand the person s communication systems Be honest (ask the person again, or ask someone else that knows the person to support you)
46 Strategies to Help Understanding Be face to face Get the person s attention Remove distractions Talk about what to do, not what not to do Give one part of an instruction at a time Show or demonstrate to the person what you want Use facial expression and gestures
47 Strategies to Help Understanding Use visual cues; key word sign, pointing, objects, timetables Use speech with visual cues rather than speech alone Use context. E.g. Be in the kitchen when talking about dinner Use clear, simple language Use words that are easy to visualize or see Use the basic or common form of the word, E.g. table rather than desk
48 Activity: Simple Sentences Can you make the sentences simpler and easier to understand?
49 On the job If you are having difficulty communicating Use your strategies Look in the person s file and ask someone who knows him/her Discuss your concerns with others Contact a speech pathologist
50 Resources InterAACtion Manual PrAACtically Speaking Video and Manual Spectronics Website Novitatech Goossens and Crain resources: for children and adolescents, but somewhat adaptable. NECAS A&EP ComTec
51 Communication and Inclusion Resource Centre Communication and Inclusion Resource Centre: Provides information, advice, training, resources & services in the areas of CCN, saliva control & swallowing. Team of Speech Pathologists, Occupational Therapist & Community Development Workers. 830 Whitehorse Road, Box Hill, VIC Ph: (03) Toll Free:
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