Communication and Disability Speech and Language Therapy Joint Training 2008

Aims of today’s session What is ‘Communication’? The role of the Speech and Language Therapist in Communication. Identify breakdowns in communication. Ways of communicating effectively with people who have a communication disability. The Mental Capacity Act and communication.

Role of the Speech and Language Therapist Formal and Informal Assessment of communication difficulties. Advice to client and/or carer re; how to communicate effectively Therapy to optimise Communicative ability. Provision of Alternative and Augmentative Communication Aids (AAC) where appropriate. Liaison with the MDT re; communication needs and strategies.

What is communication? A transfer of information between two or more people.

What does successful communication involve? More than one person A need/desire to communicate Opportunity A means of communicating

How do we Communicate? Eye contact Facial expression Gesture Posture Voice Speech Cognition Comprehension of Language Intonation

How do we communicate… Cont’d Ability to express oneself Listening Concentration/attention Memory Hearing Reading/writing visually

Cycle of Communication The brain hearingBreathing Speech sound Production of Productionvoice

Practical exercise Get into pairs. One of you must describe the picture you see to your partner so that they can attempt to copy the picture as accurately as possible without seeing it. Think about what methods you are using to convey the information.

Communication Breakdown What do you think might affect someone’s ability to communicate effectively?

Communication breakdown (2) Poor Hearing/vision Difficulty understanding language No facial expression Difficulties with reading/writing Difficult articulation Lack of /quiet voice Poor memory/attention Poor Cognition

Reasons for Communication breakdown Stroke (CVA) Head Injury Degenerative diseases (eg; Parkinson’s disease, Motor neurone disease, MS etc) Cancer Dementia Infections Psychogenic

Specific Communication disorders Dysphasia – This is a disorder of language and can affect both receptive and expressive routes. i.e.; comprehension of language or reading. The inability to express one’s thoughts via putting words together, difficulty forming the sounds or writing. (Picture description task)

Specific Communication disorders(2) Dysarthria - This is a weakness of the oromusculature. It is normally secondary to neurological or nerve damage. It is characterized by slurred speech. (practical exercise – talking without using tongue/lips, eating sweets with lips open)

Specific Communication disorders(3) Dyspraxia - This is a breakdown in the coordination between brain and muscle, where automatic movements are easier than planned movements. (Practical exercise – writing name backwards, rubbing head/tummy, red lorry/yellow lorry)

Specific Communication disorders(4) Dysphonia - This refers to a partial loss of or change in the quality of voice. It may be characterized by a weak, rough or breathy voice. Watch video – the anatomy of the voice

Specific Communication disorders(5) Dysfluency - This is another term used to describe a stammer or a stutter. The first sound of a word or the whole word may be repeated or prolonged.

Practical Exercise Look at the menu that you have been given. Do you know what you will order? If not, why not? What would make it easier for you to understand the menu?

Video Video of stroke pts here – Dr training Can’t remember what it’s called!

Other Communication difficulties Head and Neck cancer - Sometimes this may necessitate radiotherapy and/or surgery. Radiotherapy may cause inflammation and pain which may impact on an individual’s communication e.g. voice/articulation. Surgery may leave an individual with incomplete articulators or decreased sensation. E.g. of the lip and/or tongue. This may require therapy to teach the patient how to compensate.

Other Communication difficulties Dementia - This is characterized by a slow insidious onset. Often beginning with loss of memory and cognition. Language structure often remains intact but the content becomes inappropriate to the context and they become increasingly disorientated to time and place.

Effects of Communication disorder Psychosocial effects –Isolation –Frustration –Misunderstanding –Needs unmet –At risk eg with medication –Breakdown in relationships –Loss of independence/Job/finance

Role of the SLT To carry out a detailed assessment in order to determine level of breakdown. –How much are they able to understand? –In what modality (eg respond best to speech/ visual etc)? –How do they communicate best? –Specific strategies to help –Advice for pt/family and carers

Strategies to help Speak slowly and clearly. Keep your language simple and sentences short. Consider repeating what you have said if the other person appears to be struggling to understand or hear you. Presenting the information another way e.g. writing it down, using pictures, pointing. If you do not understand what someone else has said, do not pretend that you have. Tell them that you did not understand and ask them to repeat it.

Strategies to help cont’d If you are unable to understand what someone has said despite asking them to repeat it, encourage them to use writing or drawing instead. Gesture can sometimes help to clarify information – you can use your face, body or hands.

Alternative and Augmentative Communication (AAC) Sometimes, the Speech and Language Therapist may suggest the use of a communication aid for some people. Each person will require in depth assessment in order to see if they would benefit from AAC and if so what type would suit them best. AAC is largely divided into hi and low tech devices. (show some examples)

Dysphasia and decision making Mental capacity is the ability of a person to make an informed decision when given all the facts. Levels of capacity may vary as the person may have comprehension or expressive difficulties. Capacity may vary as the persons medical condition changes.

Dysphasia and decision making cont. If someone is unable to understand or weigh up the information relevant to a decision, they may lack the capacity to make a particular decision about, for example; consent to treatment. This does not mean that they are then unable to make everyday decisions about what they eat or wear.

Speech & language Therapy and The Mental Capacity Act We work in the Best interest of the individual We can assess an individuals communication difficulties so the optimal means of communication can be used (e.g. gesture/pictures/writing etc). If the individual has an advocate who can act on their behalf then we will contact them to discuss how to optimise the client’s communicative ability.

The Mental Capacity Act The Act says that as professionals we must presume that everyone has capacity and an unwise decision does not mean that a person lacks capacity. Any communication difficulties must be individually assessed so that the best, most effective method of communication can be used to aid the client’s ability to make and communicate their decisions. In the case of people who have English as a second language an interpreter should be appointed.

How to refer We operate an open referral system for communication. This means that anyone can refer, including the patient themselves. We will need the following information; name, d.o.b, address, GP, Reason for referral. The patient must be aware of the referral and agreeable to it. Referrals can be sent to; –Therapy services building RSH(S) Mytton Oak road SY3 8XQ Or Telephone: /Fax: