Assistive Communication devices are often viewed as part of a therapy treatment rather than a tool required for medical needs. However, consider this scenario: A child goes into the hospital for a few days. He has complex communication needs and often cannot verbalize. The hospital staff typically rely on the parents to either assist in communicating with the child or they speak directly to each other, completely excluding the child from the conversation. When the parents leave, nurses and staff often struggle to properly communicate with the child. When hospital staff has little to no training in assistive communication strategies, it results in frustration for both parties and a staff concern that they may not be completely fulfilling the child’s needs.
At school and home, the child uses an Augmentative and Alternative Communication (AAC) device. Why was the device not sent to the hospital with him? A study in Australia, Supporting communication for children with cerebral palsy in hospital: Views of community and hospital staff, found that most parents did not bring their child’s AAC device into the hospital setting for a variety of reasons. One main reason is the environmental barriers. There is a lack of space in most hospital rooms which may make it difficult to access the device from the bed. Another reason is the replacement cost of the device should it be lost or broken. Finally, many in the study had the assumption that the device is used as a therapy tool only, and would not be needed in the hospital.
The results of the study showed that when a child (or a person of any age) communicates with a familiar assistive communication tool, their hospitalization period is more effective and enjoyable. This is primarily due to the fact that they are able to accurately communicate their physical needs and they are able socialize with the team providing care.
Of the nurses who participated in the study, most admitted to having limited knowledge of assistive communication strategies. They assumed several of the high tech options would be complex, time consuming to learn, and labor intensive to use. With many individual patients to attend to and only a short period of time with the each of them, the nurses felt they did not have time to spend with parents pre-surgery in order to learn how the child communicates, what (if any) tools and devices are used, and how to use them.
What can be done to remedy this situation? In addition to the suggestion that hospital staff should receive more formal training on the use of AAC, it is advised that the roles of hospital-based Speech Language Pathologists (SLP) and Occupational Therapists (OT) are expanded to allow time to confer with the patient’s community-based SLP and OT, and to perform a short functional assessment. Parents and families would be counseled to send AAC devices and communication aids to the hospital with instructions on how to use the tools and an outline of how their family member communicates.
The recent shift in AAC technology has introduced mobile applications. This means smaller, more portable devices that can be used anywhere. Enhanced mobile applications have recognized the need to accommodate switch technology for those who are limited in their mobility – reducing environmental barriers completely.
Reference: B. Hemsley et al. (2013) Supporting communication for children with cerebral palsy in hospital: Views of community and hospital staff. Developmental Neurorehabilitation, 1-11. Available online here.