To facilitate is to make easier. In facilitated communication the task of using a communication aid is made easier for a person with a severe communication impairment. The degree of facilitation needed varies from person to person, ranging from an encouraging hand on the shoulder to boost confidence, to full support and shaping of a student's hand to enable isolation and extension of an index finger for pointing.

Facilitation may be most useful for people with severe communication impairments.

Facilitated pointing can provide a temporary remedy for the hand function impairments of some of these people, and may result in a permanent improvement in hand function when used as part of a structured teaching program.

Facilitated communication training is a strategy for teaching individuals with severe communication impairments to use communication aids with their hands. In facilitated communication training a communication partner (facilitator) helps the communication aid user overcome neuro-motor problems such as impulsivity and poor eye/hand co-ordination and develop effective pointing skills.

The immediate aim of facilitated communication training is to allow the aid user to make choices and to communicate in a way that has been impossible previously. Practice using a communication aid such as a picture board, speech synthesizer, or keyboard in a functional manner is encouraged, to increase the user's physical skills and self-confidence and reduce dependency. As the student's skills and confidence increase the amount of facilitation is reduced. The ultimate goal is for students to be able to use the communication aid(s) of their choice independently.

Use of facilitated communication is not restricted to any specific age or diagnostic group. It has been used successfully by people with diagnoses including autism, down syndrome, intellectual disability, cerebral palsy and acquired brain damage. For facilitated communication training to be considered as an option for an individual they will:

Once it has been decided that an individual is a candidate for facilitated communication training it is then necessary to:

The individual with severe communication impairments can now practice using a communication aid with facilitation. This is just the start of the training program. Further teaching and assessment in areas such as literacy, hand function, and pragmatic interactive skills will be required.

If the person with severe communication impairments shows the ability to spell at the initial assessment further assessment and refinement of literacy skills is desirable. If the person does not show usable spelling skills then involvement in a literacy program is desirable. Spelling is the most empowering communication strategy for people who cannot speak or sign fluently, and every effort should be made to develop literacy skills in such people. Infants and individuals for whom literacy acquisition is problematical need to be taught as large a vocabulary of pictures and symbols as possible.

Given that the individual is using facilitation because of problems with hand use, regular hand function assessments, which may result in the prescription of exercise routines or splints, are important.

Whatever the representational strategy used, all communication aid users need to be taught acceptable attention-getting strategies and other pragmatic skills, such as how to position themselves in relation to people they are communicating with.

Multiple communication partners should be trained in order to avoid dependency on any one facilitator. The amount of facilitation provided requires regular review with the aim of reducing it as quickly as possible.

What benefits does facilitated communication training offer?

Communication changes the lives of people with disabilities and their families and friends.

Facilitated communication training has enabled some people without functional communication to take charge of their lives, make their wishes known for the first time, and join the life of their communities. Parents have been enabled to communicate with their children. Children who have had only restricted education, or no education at all, have gone into regular classes; some have completed high school and gone on to university. For some people with challenging behaviours frustration has been relieved and behaviour has improved.

Facilitation is controversial

Facilitated communication has been criticised by some professionals as an unproved technique that is open to abuse and can lead to words being put in the mouth of a person with a disability. For more details on the debate and a list of publications, go to the home page of the Facilitated Communication Institute, Syracuse, New York.