April 11, 2023. National Students of Speech Language and Hearing Association (NSSLHA) By Abigail Sepulveda.
For most people, the ability to express themselves through speech comes naturally and with little effort. For others, a disorder such as autism, or an illness such as a stroke or neurogenic disease, has left them isolated and unable to communicate with others. Fortunately, those people can use augmentative and alternative communication (AAC) to communicate and interact with others. AAC consists of a range of tools used to assist with communication. From simple pointing to pictures on a communication board to the use of computer technology to produce speech, AAC can be a powerful tool to restore or improve a person’s quality of life through access to communication with others. To illustrate this point, let’s look at a person on my caseload who recently experienced a life-changing stroke.
The Face Behind AAC
*Frank, a middle-aged former restaurant owner, was receiving intensive, inpatient rehabilitation after a stroke left him unable to communicate with the exception of one- or two-word utterances. Although he could understand simple questions posed by nursing staff, he was unable to respond and make his needs known. As a graduate clinician providing speech therapy, I worked with Frank to create a low-tech AAC booklet that he could use to communicate with hospital staff. In addition to creating this communication booklet, we also placed signs in Frank’s room to encourage hospital staff to use the communication booklet when interacting with him—along with a list of specific strategies to facilitate communication.
One afternoon, I encountered two flustered staff members exiting Frank’s room. Tensions were high as I entered to find him breathing heavily, red-faced, and with tears forming in his eyes. Frank repeatedly exclaimed, “Frustrated!” and “Bad experience!” Forty-five minutes later, we finally understood the cause: Frank had needed to use the restroom, a request that the two staff members did not understand. I asked where Frank’s communication booklet was, and his response was a defeated shrug. After some searching, I found it stuffed into a cubby in his hospital room. This encounter resulted in not only Frank’s restroom request not being met but also hurtful comments being made—in Frank’s presence—regarding his “noncompliance” and his size. The misuse of AAC—or lack thereof—was a blow to Frank’s dignity and fueled the frustration for both the patient and the staff.
Communicating With Multidisciplinary Treatment Teams
Although I would like to say that Frank’s experience was an isolated incident, it is an unfortunate representation of many scenarios that play out across a multidisciplinary team. Whether you are working in a medical facility, school, or private practice, you will be working with other professionals. As a result, as an undergraduate or graduate student, you will most likely have an experience similar to mine in the coming years.
If you do encounter something similar in an externship, in your clinical fellowship, or in professional practice, my best advice is to seek to a patient’s communication needs gently and graciously and at an appropriate time—preferably not in the heat of the moment. For example, if you’re in a school setting, stop by the classroom teacher’s room before school starts, or chat with the occupational therapist during weekly team meetings. Initiate the conversation with a question, such as “Is there anything I can be doing in therapy to support the goals you have been working on?” I have done this several times with occupational therapists, physical therapists, and classroom teachers to open the door to a discussion about patient-centered care.
I have also advocated for a patient by posting a sign in their room to prompt staff and family members to use the AAC board. I also list specific strategies that worked well with that patient to facilitate communication, such as writing keywords on a whiteboard, asking one question at a time, or providing extra time for a response.
Why Prioritize Communication?
According to the American Speech-Language-Hearing Association (ASHA), Frank is one of more than 2 million adults and children in the United States who utilize AAC to access their human right to communicate. As a result, interdisciplinary education and training on AAC should be prioritized to support patient-centered care. Sarah Blackstone, a speech-language pathologist (SLP) and president of Augmentative Communication Inc., emphasizes—in an article published with Michael Williams and David Wilkins in Augmentative Communication News—that appropriate patient–provider communication is fundamental to patient-centered care. The authors also highlighted that patient–provider communication strongly correlates with increased patient safety, satisfaction, and health outcomes.
Currently, many health care providers lack awareness of the many communication challenges that patients face. Although some providers do have the education on how to support patient communication, often they provide such support inadequately. Facilities may have communication resources and strategies available to them, but such resources and strategies are not useful if providers do not appropriately use or implement them.
As Future Practitioners, What Can We Do?
It is imperative that the degree to which health care providers prioritize the human right to communicate be proportional to the training and education provided at the university level. As such, there are several ways for providers to accomplish the goal of supporting AAC in health care while enrolled in higher-level education programs. This could take the form of an interprofessional education and interprofessional practice (IEP/IPP) project that requires collaboration among different degree programs—such as a collaboration between nursing and speech-language pathology. Similarly, incorporating a required in-service learning opportunity across disciplines could provide an avenue for necessary interprofessional education. An additional way of integrating the education of—and knowledge about—AAC into health care programs is by incorporating such information into already existing coursework or offering an AAC elective class. These suggestions are simply the first steps toward providing the key for our patients that unlocks their essential human right to communicate.
AAC Resources for Clinicians
For a general understanding of AAC and the role of the SLP, visit ASHA’s webpage on AAC. Another resource is the AAC Institute, which has online courses and handouts with practical information for evidence-based clinical practice. Inclusive School Communities also provides free webinars on current issues threatening equal access and inclusion for students with disabilities. For those working in a school setting, this handoutfrom Communication AACtualized is a good example of a consolidated resource that describes aspects of effective instruction for individuals using AAC. Finally, I have enjoyed listening to the Talking With Techpodcast. Hosted by two SLPs, it provides resources, clinical guidelines, and current research for clinicians who want to maximize technology to support their clients who have complex communication needs.
Although you may not have had a “Frank” on your caseload yet, there is a strong likelihood that you will at some point in your career. My final advice is this: Don’t wait until you have a client with complex communication needs to educate yourself and to find resources. Do the legwork now, and create a digital resource file with research articles for best practice, practical resources, and educational handouts for professionals from other disciplines.
*Name was changed to protect patient privacy.
Abigail Sepulveda is a graduate student studying communication sciences and disorders at North Carolina Central University, where she is a 2022–2023 North Carolina Albert Schweitzer Fellow.