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?
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More than one person
A need/desire to communicate
Opportunity
A means of communicating
How do we Communicate?
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Eye contact
Facial expression
Gesture
Posture
Voice
Speech
Cognition
Comprehension of Language
Intonation
How do we communicate… Cont’d
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Ability to express oneself
Listening
Concentration/attention
Memory
Hearing
Reading/writing
visually
Cycle of Communication
The brain
hearing
Breathing
Speech sound
Production
Production of
voice
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)
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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 2005.
• 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 2005.
• 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: 01743 261417/Fax: 01743 261067