NICOLA VERITY

1
Communication Awareness

• NICOLA VERITY
• Speech Language Therapist
• nicola.verity2_at_bradford.nhs.uk

2
Programme Overview

• Terminology solved
• Insight of patient perspective
• Strategies to facilitate communication
• Referrals

3
Terminology

• What are we talking about?

4
Aphasia

• Loss / impairment of language caused by damage to
  the brain
• It can affect understanding speech, reading,
  talking and writing
• Sometimes called dysphasia
• Estimated 20-30 of stroke survivors experience
  aphasia
• 6 months post-stroke 15 still have aphasia
• (Royal College of Physicians, 2004)

5
Dysarthria

• Difficulty with the physical production of spoken
  sounds and words
• Weak and slow movements of the lips, tongue, soft
  palate, jaw, vocal folds and muscles for breath
  support make speech unclear
• Facial weakness
• Speech may sound slurred, breathy, weak,
  laboured, too quiet, mumbled
• Single words may be clearer

6
Verbal Dyspraxia

• Trouble programming and coordinating the muscles
  required for speech in the absence of muscular
  weakness
• Automatic phrases may be easier
• Confrontational tasks are harder
• Trial and error and groping for sounds may be
  observed
• Variable

7
Possible Consequences of Communication
Difficulties

• Withdrawal from social situations
• Isolation
• Unemployment
• Loss of leisure pursuits
• Loss of friends

• Frustration
• Anger
• Upset
• Feeling stupid
• Depressed

Sarno (1997)
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Barriers to Communication

• Emotional state
• Communication environment
• Conversation partner (s)
• Ability confidence, severity of impairment
• Lack of opportunity

9
Why do we need to know about communication
difficulties?

• Impact on the client
• Impact on family and carers
• Impact on rehab

10
What can we do?

• The purpose of communication - Why?
• The medium of communication
• - How?

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Conversation key messages

• Being involved in good conversations can improve
  confidence and quality of life
• Conversation with people with communication
  difficulties requires skills, behaviour changes
  and resources these are techniques which
  everyone can learn
• Conversational success and breakdown is the
  responsibility of both people

12
Adapt your style to facilitate communication!

• Supported Conversation
• Message in
• Make sure the person with aphasia has understood
• Message out
• Make sure the person with aphasia, dysarthria or
  dyspraxia has opportunities to express themselves
• Acknowledging competence
• Keep the conversation adult and natural, show you
  acknowledge their expertise

13
Message inensuring the person with aphasia
understands

• Reduce background noise and distractions
• Use alerting signals to let the person know you
  are speaking to him/her
• Check the client has their glasses and hearing
  aid if needed
• Keep phrases short
• Make your speech less grammatically complex
• Use everyday words instead of long, complex or
  abstract ones
• Repeat and emphasise key words
• Write down key words

14
Message in

• Slow down but try not to be patronising
• Use pauses between words and sentences
• Have a pen and paper handy to draw or write key
  ideas down
• Use photos, pictures and objects relevant to the
  topic youre discussing
• Use gestures, body language, facial expression
  and pointing to support your speech
• Check that the person is following are you
  with me?
• Keep the conversation balanced

15
Message out..

• Quiet environment with no distractions
• Speak face to face
• Give him/her your full attention
• Be patient
• Make sure the client has a reliable way of
  responding to yes/no questions e.g. pointing to
  written yes/no, thumbs up/down, head nod/shake
• Encourage the use of pen and paper and other
  props such as photo albums, magazines,
  diary/calendar, objects, maps, communication
  picture chartsGather these beforehand.

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Message out

• Encourage the use of body language, facial
  expression, gestures and pointing to get their
  message across - use it yourself
• Get to know the persons preferences e.g. what
  type of help they like and dislike
• Get to know his or her communicative strengths
  and encourage them
• Dont interrupt or guess too soon
• Keep re-capping to check youve understood
  correctly
• An alphabet chart, communication book or a voice
  output communication aid may be suitable

17
Conversation breakdown

• Stay relaxed and try to solve the problem
• Check if its really important
• Agree a signal to stop and move on
• Ask permission to leave until later
• Make a record of what youve learned so far and
  return to this later if you have further thoughts
• Dont pretend youve understood when you havent

18
Practice makes perfect

• Activity exchange messages using supported
  conversation
• Re-group and share

19
Referrals

• Open-referral
• In-patient referrals to SALT departments at
• SLH Tel 365220 Fax 365443
• BRI Tel 366517 Fax 366946
• Community hospitals and clients at home-
• Speech and Language Therapy
• Leeds Road Hospital
• Maudsley Street
• Bradford
• BD3 9LH
• Tel [phone]
• Fax [phone]

20
Useful contacts

• Speakability
• www.speakability.org.uk

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Stroke Association
www.stroke.org.uk
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• Connect
• The communication disability network

www.ukconnect.org.uk