Tips and Tricks to Support Communication - PowerPoint Presentation

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Tips and Tricks to Support Communication in Aphasia

Cordelia

Peters, MS, CCC-SLP

Jeannine Alleva, MS, CCC-SLP

BIAMD Conference March 23, 2017

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Learning Objectives

Identify 3 different ways to support expression in persons with aphasia (PWA)

Provide 2 ways to ensure understanding in PWA

Name a scale to objectively measure supported communication

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What is Aphasia?

Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is always due to injury to the brain, most commonly from stroke, but also can arise from head trauma, tumors or infections - NAA

Aphasia is a language impairment that affects your ability to speak, write and understand verbal and written language.

It is a condition that robs you of the ability to

communicate.

– Mayo Clinic

New / expanded definition

An acquired

neurogenic

language disorder that may mask inherent competence normally revealed through

conversation.

– Aphasia Institute

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What is Conversation?Exchange of information

Key to engaging in our community

Two parts to conversation

Transaction

exchange of information that encourages interactions

Interaction

Social and/or emotional connection

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What is Communication?The act or process of communicating to express or exchange information by imparting:

Thoughts, opinions or information by using words, signs, sounds or behaviors

Does aphasia “rob the ability to communicate”…. or rather persons with aphasia CAN communicate but their ability to PARTICIPATE in CONVERSATION is limited because their communication is NOT SUPPORTED?

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A-FROM: Aphasia Framework for Outcome Measurement

Addresses the lack of an integrated approach in evaluating outcomes of aphasia that is not just focused on the impairment level of PWA.

Initially funded by the Ontario Stroke System (Grant 06021).

Based on the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF).

The classification system focuses on:

functioning

, which refers to all body structures, functions, activities and participation

disability, which

refers to the impairments, activity limitations and participation restrictions associated with health conditions.

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A-FROM: Aphasia Framework for Outcome Measurement

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A-FROM: Aphasia Framework for Outcome Measurement

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Why use supported communication?

PWA experience:

Increased dependency

Frustration

Fear

Depression

Decrease in other’s perception of their competence

Exclusion from personal, leisure and health choices

Environments that are not supportive

Lack of control

Poor confidence

Loss of self

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What is supported communication?

A communication method that helps to facilitate a conversation with PWA.

Teaches the PWA and his/her communication partners how to use multi-modal communication to support both expressive and receptive communication.

Emphasizes opportunities for social interaction at home and in the community.

Helpful for people with other communication challenges such as:

Poor literacy

Cognitive communication impairments (not aphasia)

Non or limited English speaking.

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How is it Supportive?4 Steps

Acknowledge competence

Reveal competence

Information “In”

Confirms PWA can understand

Enable expression (verbal or nonverbal)

Information “Out”

PWA has a means of responding

Verification

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1. Acknowledge

competence

Highlight their abilities - “You are really good when you write”

Validate their frustrations

Directly confirm their competence:

“I know you know” or “Lets try it again so we can make this work”

Indirectly confirm their competence:

Speak naturally, normal loudness and use an adult tone

Be aware of your body posture, humor and eye contact

Be sensitive to their needs and amount of support provided

don’t apply too much or too little

Involve the PWA in conversations, even if they are too complex.

Attribute communication breakdowns to your limitations as a communication partner - “I am just not getting it”

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2. Reveal competence

Ensure Understanding

Objective is to determine that the message provided is clear, concise and understood.

Set up the environment by eliminating distractions, give wait time for processing and utilize repetition.

Use short sentences and natural gestures.

Ask general to specific questions to introduce the topic and narrow down details of the conversation.

Hierarchy of revealing competence - includes talking

in conjunction with utilizing …….

Gestures

Writing

Key words of the conversation

Circle key words to refocus the conversation or emphasize a point

Use lines to underline and connect thoughts

Provide multiple choice options to find the focus of the conversation

Max of 5 per page and use a black marker for high contrast

Pictures/objects – pictographic resources

Drawing

Observe PWA to assess comprehension of the message

Facial expressions, body language, eye contact or gaze

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Examples of Revealing Competence

Aphasia Institute Resources 2016 - www.aphasia.ca

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3. Enable

expression

(

verbal

or

nonverbal

)

Provide a way for the PWA to respond

Give them time, make sure they have access to:

Yes / No responses

Written multiple choice options

This includes written key words that partners have provided in the conversation so they do not have to rely on their memory.

Pictographic materials

Paper/Pen or an Alphabet board

Ask one question at a time

Request gestures – “Can you show me?”

*The SLP plays an important role in both revealing competence and enabling expression, as they determine what modality works best, and can accurately train family and friends to be better communication partner s*

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4. Verification

A continual fluid process that occurs throughout the conversation.

Ensures that your understanding is accurate as a partner. Verify what you think they mean.

Reflect and repeat key words or concepts in the conversation

Expand on the key concepts

Fill in the gaps, add what you think the patient might be trying to say

Summarize

After longer conversations, pull together everything.

“Let me make sure I got it.”

Summarize slowly with multi-modal communication, using written keywords and gestures if needed.

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Measuring Supportive Communication

Rating Support and Participation in Communication

Measure of Skill in Supported Conversation (MSC) (for the communication partner)

Rates the ability of the communication partner to acknowledge and reveal competence

For this scale revealing competence includes the last 3 stages of supported communication – ensuring understood, that the PWA has a way of responding and verifying the conversation in summary.

Measure of Level of Participation in Conversation (MPC) (for the PWA)

Rates the ability of the PWA to participate in conversations through their transactions (exchange of information) and their interactions (social/emotional connection)

Kagan

, A.,

Winckel

, J., Black, S.,

Duchan

, J. F., Simmons-Mackie, N., & Square, P. (2004). A set of observational measures for rating support and participation in conversation between adults with aphasia and their conversation partners. Topics in Stroke Rehabilitation, 11(1), 67-83.

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Supported Communication

Non-Supported

Communication

• Uses multiple

modes

(writing, gestures, AAC,

pictographic)

• Uses mostly verbal communication

• Uses normal prosody

and

non-verbal body

language

• Uses

p

oor eye contact, intonation

/

“baby-talk”

• Checks understanding and repeats as necessary

• Interrupts, dominates conversation

and

assumes

understanding.

• Provides wait time

• Talks for long periods of time.

• Frequently comments

on partners attempts and

utilizes

short sentences

•

Uses

complex and lengthy

language. Ignores

partners attempts.

• Introduces and maintains topics.

• Doesn’t introduce topics, switches topics quickly.

•

Practices g

ood listening

and

acknowledges all

attempts

•

Demonstrates p

oor listening, is degrading, “you

forgot” or “I know you can’t get that word.”

• Cues partner to use multi modal communication

and o

ffers choices to clarify.

• Doesn’t encourage other types of

communication

or

fails to cue

and offer choices.

• Requests logical and appropriate clarification. “I

think you are talking about ____, right?”

• Non specific requests for clarification “What was

that?”

• Allows for and sets up communication

opportunities

and

requests input.

• Doesn’t request input/opinion, nor

allow for

communication opportunities.

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Supported

vs.

Unsupported Communication video

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References

American Speech-Language-Hearing Association (ASHA) (2007).

Supported Communication Intervention for Aphasia

. Rockville, MD: American Speech-Language-Hearing Association (ASHA).

Hilari

, K., Owen, S. &

Farrelly

, S. J. (2007). Proxy and self-report agreement on the Stroke and Aphasia Quality of Life Scale-39

. Journal of Neurology, Neurosurgery and Psychiatry

, 78(10), pp. 1072-1075.

Kagan

, A., Simmons-Mackie, N., Rowland, A.,

Huijbregts

, M.,

Shumway

, E., McEwen, S., Threats, T., Sharp, S. (2008) Counting what counts: A framework for capturing real-life outcomes of aphasia intervention

.

Aphasiology

,

22(3): 258-280.

Ross, K.B.,

Wertx

, R.T. (2003) Quality of life with and without aphasia.

Aphasiology

,

17, 355-64.

World Health Organization (WHO) (2001

). International classification for functioning, disability and health (ICF).

Geneva, Switzerland: World Health Organization.

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Questions?

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Tips and Tricks to Support Communication in Aphasia

Cordelia

Peters, MS, CCC-SLP

Jeannine Alleva, MS, CCC-SLP

BIAMD Conference March 23, 2017