1. The Communication Toolbox: Practical strategies for facilitating communication Susan Howey Speech-Language Pathologist Stan Cassidy Centre for Rehabilitation

2. Aphasia Difficulty in formulating, expressing, or understanding language Impairment in using a symbol system (language) to communicate ? ?

4. Key Objectives What is my role in communicating with a person with aphasia? What are the 2 key questions that I need to answer when facilitating communication? What are 7 of the most important strategies I can use to facilitate communication?

5. ACCESS

6. ACCESS Communication access ??

7. ACCESS You (conversation partner)

8. Experiences of aphasia

9. Question #1 Am I being understood?

10. How to get your message in 1) Control the flow of information: Take your time Simplify: Use short, uncomplicated sentences

11. How to get your message in Control the flow of information: (cont’d) Keep your message focused: One idea at a time Make it clear that you are changing the subject

12. How to get your message in 2) Supplement speech with visual cues: natural gestures, pointing, and visual aids

13. How to get your message in Have a pen and paper handy: Write down key words

14. Dr. Jones TODAY 10:30

15. How to get your message in 3) Check to see if you were understood

16. EXAMPLE “Mr. Smith, I want to tell you about an upcoming event” (bring pen, paper, calendar) “On Tuesday,…” (point to calendar, write down Tuesday) “…the Kent Brothers’ Band is coming to play” (write down Kent Brothers’ Band)

17. EXAMPLE (cont’d) “They’ll be playing downstairs in the auditorium.” (point in direction of location) “Would you like to go?” (Point to person, write down question) “Great. So on Tuesday, you’ll be going to the concert.”

18. Question # 2 Does the person have a way to respond?

19. How to help get their message out Successful communication is the goal – regardless of how the message is communicated

20. How to help get their message out 1) Encourage multimodal communication Speaking Pointing – objects or pictures Gesturing Showing you what they are talking about Writing down a word or part word Drawing Intonation/ facial expression

21. Communication myth A “communication board” will ensure that we are addressing communication needs

22. How to help get their message out 2) Closed-Ended Questions Yes/NoChoice

23. How to help get their message out Yes/No questions – response modes Verbal Verbal Head nod/shake Head nod/shake Pointing to the words Pointing to the words Gesture (e.g., thumbs up/down) Gesture (e.g., thumbs up/down)

24. Communication myth Using yes/no questions is usually the best way to help the person with aphasia express what they would like to say

25. ROOM REST?? REST??

26. How to help get their message out Choice questions: options Provide verbal choices Write choices down Give a choice of objects Give a choice of pictures

27. How to help get their message out Closed-ended questions Attempt to identify the general topic first, then narrow your questioning Broad  Detailed

28. How to help get their message out 3) Verify that you understood the message correctly - by rephrasing or paraphrasing their idea, then watching/ listening for confirmation Include other cues as needed: Include other cues as needed: Write down key words Write down key words Use visual aids Use visual aids Draw Draw

29. Acknowledge Competence E.g., “I know that you know”; “I know you have something specific to say – I’m just not quite getting it yet” Give the person time to get their ideas across Avoid speaking about the person with aphasia as if they are not in the room If you need to direct questions to another person, ask for permission first

30. EXAMPLE “Hi Mrs. Smith. You seem upset.” Multi-modal: “Can you show me what’s wrong?” If this does not help her to get her point across, use closed-ended questions to elicit information – begin with general topics (use her facial expression, gesture, pointing to help you make an initial guess) (use her facial expression, gesture, pointing to help you make an initial guess)

31. EXAMPLE Write down key words – cross off inaccurate guesses; circle correct information ROOMTHERAPY

32. SOCIAL WORK RECOTPTSPEECH Something Else

33. EXAMPLE When you feel you understand, summarize (speak, write, draw, gesture) and look for confirmation THERAPY SCHEDULE LOST

34. In a tough spot… If you get stuck, be honest – “I know you’re trying to say something specific, and I just can’t figure it out yet.” Then summarize what you know so far, and let the person know that you can come back to it later.

35. “Toolbox” Black marker Black marker Blank paper Blank paper

36. “Toolbox” The strategies you use as a conversation partner Message in Message out

37. Review

38. Your role To enhance communication access by becoming a skilled communication partner

39. 2 Key questions Am I being understood? Does the person have a way to respond?

40. 7 important communication strategies 1) Acknowledge competence Message in: 2) Control the flow of information 3) Supplement speech with visual cues 4) Check to see if you were understood Message out: 5) Encourage multi-modal communication 6) Use closed-ended questions 7) Check to make sure you understood the message

41. Thank you!