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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