As we age, we become more liable to a number of conditions that can affect our communication. The same techniques that work with people who have communication impairments can sometimes help with older people with communication problems - and they're not complicated, not expensive, and always worth looking in to.

DEAL has written a book covering communication techniques to use with this group. It was specifically designed for nursing home residents, but the same principles apply.




Previous chapter here.
 
14.  Assessment, Therapy and/or Equipment Services
Some services offer advice and assessment regarding augmentative communication aids.  Training in the use of devices may also be provided.  A number of the following services are able to loan equipment for people to trial. 

ACT:
Assistive Technology Clinic
    Tel:
 
New South Wales:
Computer Assistive Technology Service  (Northcott Society)
    Tel: (02) 9890 0100    Fax: (02) 9683 2827
Assistive Technology Services, (Spastic Centre of NSW)
    Tel: (02) 9451 9022    Fax: (02) 9451 4877
Biomedical Engineering, Northern Sydney Area Health Service
    Tel: (02) 9926 7226     Fax: (02) 9906 1685
Rehabilitation Engineering, Royal South Sydney Hospital
    Tel: (02) 9382 8109    Fax: (02) 9382 8140

Northern Territory:
NT Disability Resource Unit (DRU)
    Tel: (08) 8922 7260    Fax: (08) 8922 7482

Queensland:
Assistive Technology Resource Centre (Cairns)
    Tel: (07) 3397 1224    Fax: (07) 3394 1013
Equipment Technology Services
    Tel: (07) 3865 4377    Fax: (07) 3865 2285
Biomedical Engineering, Royal Brisbane Hospital
    Tel: (07) 3253 7412    Fax: (07) 3253 1389
Technical and Therapy Services, Cootharinga Society of North Queensland
    Tel: (077) 714 030    Fax: (077) 211 457

South Australia:
Technology Access Service, Regency Park Centre
    Tel: (08) 8243 8348    Fax: (08) 8243 8337

Tasmania:
Communication Access, Rehabilitation Tasmania
    Tel: (03) 6238 1801    Fax: (03) 6233 5457
Disability Support Services
    Tel. (03) 6233 8830    Southern region
    Tel. (03) 6337 4220    Northern region
    Tel. (03) 6434 6305    North West region

Victoria:
DEAL Communication Centre
    Tel. & Fax: (03) 9509 6324
Microcomputer Applications Centre
    Tel:    Fax:
Monash REHAB Tech
    Tel: (03) 9528 1960        Fax: (03) 9528 1077
CAUS (Communication Aid Users' Society – advocacy group)
    Tel: (03) 9553 8390    Fax: (03) 9553 8391

Western Australia:
Communication Aid Service, Independent Living Centre of W.A.
    Tel: (09) 382 2011    Fax: (09) 382 2896
Equipment & Applied Technology Service
    Tel: (09) 443 0211    Fax: (09) 444 7299
Rehabilitation Technology Unit, Royal Perth Hospital
    Tel: (09) 224 2500    Fax: (09) 224 1138

 
15. Australian Group on Severe Communication Impairment (AGOSCI).

AGOSCI is a special interest group of communication aid users, therapists, teachers, and other people with an interest in severe communication impairment.  There is an AGOSCI representative for each state and territory in Australia, who should be able to provide information about assessment and training for communication aid use in their state.

ACT - Judeanne Young                SA – Bronwyn Timko
Tel: (06) 288 1772                    Tel: (08) 8271 353

NSW - Beverly Peck                    TAS - Nicola Crates
Tel: (02) 9451 6999                    Tel: (03) 6434 6351
                           
NT - Megan Howitt                    VIC – Polly Morgan
Tel: (08) 8922 7260                    Tel: (03)
                   
QLD - Katy Caynes                    WA - Collette Power
Tel: (07) 3358 8020                    Tel: (09) 378 0222
                   
                           
 
16. Funding for Communication Devices
A few state governments have schemes which provide funding for the purchase of electronic communication devices.  For people who do not have access to such programmes, or are ineligible for some reason, charitable organisations sometimes help with the purchase of devices for individuals.  These include service clubs and charity groups such as the Variety Club and Rotary.    

ACT:
Funding for communication equipment in the ACT is usually done on a private basis.

New South Wales:
Funding for communication devices is available through the Programme of Aids for Disabled People (PADP). Restrictions, such as means testing, apply. 

Northern Territory:
The Territory Independence Mobility and Equipment Scheme may fund, fully or in part, purchase of communication devices, however applicants must meet the scheme's eligibility criteria.

Queensland:
There is no government scheme in Queensland which funds communication devices for residents of nursing homes. Veteran's Affairs, Commonwealth Rehabilitation Services and the Worker's Compensation board may fund devices. 

South Australia:
The Disability Services Office and the Home and Community Care Program (HACC) provide equipment funding. 
 
Tasmania:
Prescribed Aids for Disabled People (PADP) have supplied some communication aids to eligible clients. 

Victoria:
Electronic communication aids are funded through the Programme of Aids for Disabled People - Electronic Communication Devices Scheme (PADP - ECDS). Tel: 9254 5443.
Western Australia:
There is no government scheme in Western Australia which funds the purchase of devices for residents of nursing homes. 

This information was obtained from the AGOSCI News, August 1997.

17. Do’s and Don’ts for Receivers of Non-speech Communication

Do:

• be patient – We can talk at 150 words per minute; many communication aid users cannot communicate at 150 words an hour.
• be confident – Any nervousness or doubts on your part will certainly be transmitted to the aid user, usually with disastrous effects on their confidence.
• monitor your own communication – Are you talking down to the aid user?  Do you raise your voice when you talk to someone who cannot speak?  Does your interaction consist largely of orders and prohibitions?
• use the right method – Find out exactly how the user accesses the communication aid and how it should be positioned, and be consistent.  If possible, observe someone who is communicating fluently with the aid user and ask them to observe your early attempts.  Achieve success in small things before aiming for in-depth discussion.
• provide appropriate feedback – In the early stages of communication it often helps the user if the receiver says each letter or symbol aloud as it is indicated, and repeats the utterance to date at the end of each word.  Further on, the user will probably prefer it if their partner does not say the utterance aloud until it is completed (and then only if it is not private).
• pay attention – It is as important for the aid user to fell that you are interested as it is for you to feel the person you are talking to is listening.  If the aid user is inexperienced, monitor the output, and warn the user if you cannot understand so that corrections can be made before there is an irretrievable communication breakdown.
• offer word or sentence completions – Remember, the purpose of aid use is communication, not a spelling test.  Most aid users will appreciate it if you complete the word wh the mean is obv.  But do be careful not to jump in too early and put words into the user’s mouth.
• look out for abbreviations, etc. – Many aid users use contractions to speed communication, eg. RUOK.  Some use unconventional or phonetic spelling, eg. NE = any.  Interpretation is a lot easier if the user is encouraged to put spaces between words – at least then you know where one “word” finishes and the next starts.
• clarify meaning – Many users produce telegraphic utterances (as we would in their place). A user whose communication system only has a limited vocabulary obviously has no choice but to make approximations.  In these cases it is necessary to play 20 questions to ascertain the user’s exact meaning.  Make it a practice to ask the user if you’ve got it right at the end of each utterance – if the aid does not produce written output it is very easy for the receiver to muddle a sequence of words or symbols.  Equally, the aid user is as prone to second thoughts and confusion as the rest of us, but has little chance to have a second go if we don’t check.
• respond appropriately – It is easy to get so involved in the process that one forgets that the user wants a response.  You may need to ensure tactfully that others around the user also respond.  It is very discouraging to spell “Hi, how are you?” with a great deal of effort only to be ignored.
• empower the aid user – Arrange for the aid user to be able to make real choices(not just to ‘choose’ to have lunch when it is lunchtime anyway).  Act on the aid user’s requests and comments whenever possible, and explain and apologise if it is not possible.
• encourage aid use everywhere – Our communication is not restricted to particular times and places.  Neither should an aid user’s be restricted.  Inconvenience is not a good reason to refuse communication.  If the situation is really difficult, ask if the communication is urgent.  If the communication is not urgent, fix another time for a chat and stick to it.  If the problem is practical, eg. an electronic communication aid cannot be used in water, try to find a practical solution, eg. a perspex communication board.
• encourage the expression of feelings – Many aid users have used their aids only to make choices or answer basic questions, and need encouragement to enter into longer conversations and reveal more of themselves.
• respect confidentiality – If an aid user says something clearly not designed for public consumption, resist the temptation to pass it on, no matter how interesting or amusing it is.  Adults (and children) have the right not to have everything they say reported to others.  If the user’s aid produces written output make sure this is disposed of carefully unless it was written to show someone else or you have the user’s permission to keep it.
• keep up your side of the conversation – Volunteer your opinions.  Tell the aid user what you have been doing.  It is slow and tiring for the user to ask questions, and equally, it is abnormal (but unfortunately very common) for the aid user always to give information in response to your questions, but never receive any in return.
• recognise the effort and frustration involved – Using a communication aid to give a message is far more laborious, and far more likely to be misunderstood, than giving the same message in speech.  Consequently, it is important that unnecessary or repetitive questions are avoided, e.g. asking someone what they had for lunch when you’ve just fed them.
• avoid testing – Many aid users have very negative attitudes towards testing and may muck up and give rubbish answers.  After all, we are not required to establish our competence every time we open out mouths.  If we were, we wouldn’t talk very much.  The aid user who feels that every interaction is a test is likely to become resistant to the whole idea of communication.
• take the blame for failure – If the communication attempt is unsuccessful, accept responsibility.  After all, you do not have the excuse of having a communication impairment!  Saying “I’m sorry. I’m not at my best today. Let’s have another go later.” helps the aid user to maintain their confidence.

Don’t:

• be negative!

18. Suggestions for Assisting a Person with Word Finding Problems
Some people have difficulty recalling or retrieving words from long-term memory in order to speak.  This word-finding difficulty results in word substitutions, imprecise use and over-use of empty words, repetitions and dysfluencies.
The following may help if a person is having difficulty finding a word.  These strategies may be used to facilitate and improve recall and retrieval from long-term memory.

• Use an associated word, eg. say “Bread and ____” to elicit ‘butter’.
• Use antonyms, eg. say “The opposite of night is ____”  to elicit ‘day’.
• Use synonyms, eg. say “Another word for lady is _____.” To elicit ‘woman’
• Use the name of a category to elicit the name of a member of the group, eg. “It’s a fruit” or “You can use it to fix things”.
• Use serial cueing, eg. “Tuesday, Wednesday, _______" to elicit ‘Thursday’.
• Say the beginning sounds of the word, eg. “m” to elicit ‘man’.
• Say the beginning syllable(s) of a word containing more than one syllable, eg. say “Hippo-------” to elicit ‘hippopotamus’.
• Use sentence completion with a well-known sentence such as “We decorated the ________.” To elicit target words such as ‘cake’, ‘tree’, ‘table’ or ‘room’.
• Provide multiple choices, eg. say “Is it a house, a tree or a chair?” to elicit ‘chair’.

Margaret Batt, Speech Pathologist
Cathy Maloney, Speech Pathologist
Rosemary Ryall, Physiotherapist
Ashok Sethi, Occupational Therapist
Rosemary Crossley, Augmentative Communication Specialist

DEAL Communication Centre,
Melbourne
1998