Our Symposium at #IASSID2012 on July 10 2012 at International Association for the Scientific Study of Intellectual Disabilities

And so we go to … #IASSID2012 International Association for the Scientific Study of Intellectual Disabilities Halifax, Canada – on Tuesday 10th July 2.30-3.30pm

Symposium: Health communication: Participation of people with I/DD in hospital settings [Chair: Bronwyn Hemsley, The University of Newcastle]

  1. People with I/DD communicating in hospital: Needs and experiences reveal barriers and facilitators to better communication (Bronwyn Hemsley, The University of Newcastle)
  2. Communicative interactions in hospital for people with little or no functional speech: A Norwegian perspective (Susan Balandin, University College, Molde, Norway)
  3. ICF as an organizational framework for collaborative efforts related to AAC (Charity Rowland, Oregon Health Sciences University, Portland Oregon)


People with I/DD have high health service utilization rates and frequently encounter barriers to effective communication in health settings.  Problems in communicating basic care needs and information to staff impacts negatively upon their healthcare experiences, satisfaction, and patient safety.  In this symposium we will present the results of recent research conducted across three continents examining:

INTRO – Bronwyn – 5 minutes (Very brief – ICF, definitions, populations)

(a) perceptions of key stakeholders on the use of AAC in hospital and their views on the potential for collaboration to improve communication,

SUE (15 minutes): Can give overview of research in Australia and Norway that has both published results on the problem, and new data on the issues from the perspective of communication partners (nurses) in the setting, including absence of info on disability in training etc etc Australian results also have views of paid carers, adults with CCN, family carers etc – all converging to problems relating not only to the person but to their communication partners and the context,setting, time, collaboration, etc. Roles of paid and family carers will be explored.

(b) factors within the hospital environment impacting upon communicative interactions for children and adults with I/DD with little or no speech, and

BRONWYN (15 minutes): Can give results coming in relating to the ICF and observations of adults with Intellectual Disability and CCN, and CP and CCN – in hospital. Also outline study on use of the ICF in developing a code set on 75 other studies intervening for patients with communication vulnerability (ie the broader population of people with difficulties communicating) in progress.

(c) a purposefully selected core set of communication-related factors in the ICF-CY

CHARITY (15 minutes): Presenting on children who use AAC in the school setting and studies relating to the Code Set within ICF-CY.


Bronwyn (5 minutes)

The ICF / ICF-CY as a collaborative tool to guide assessment and intervention goals in the healthcare setting, and future research.

Factors affecting preparation for hospitalisation and use of generic or customised AAC systems to improve communication. Directions for future research and design of interventions for improving communication in hospital for people with I/DD will also be discussed.


Outcomes of ‘#SPAconf2012’ Workshop on Communication in Hospital for adults with developmental disability

Outcomes from #SPAconf2012 Speech Pathology Australia National Conference, Hobart, 24-27 June 2012.

Workshop: AAC in Hospital for Adults with Developmental Disability and Complex Communication Needs [Hemsley, B., Balandin, S., & Worrall, L.]

Attended by 30 Speech Pathologists – majority working in hospital settings and with adults, some SLPs in schools, community health, and adult disability services.

After hearing the findings of recent research outlining the experiences of adults with complex communication needs in hospital, speech pathologists discussed how we can make a difference – what needs to happen or to be implemented that goes beyond ‘provision of communication aids’ and a focus on ‘tools’ for communication. Participants were encouraged to ‘think online’ and ‘think tech’ and also to consider not only the patient but the provider and the health setting, and the wider environment for communication as being important. The items discussed were written down and are arranged here according to common categories across the four participant groups. Of note is the common strategy suggested of addressing broader hospital quality assurance procedures (measuring communication access), creating an ‘alert system’ and increasing strength of procedures at admission and assessment, considering management guidelines for staff similar to the dysphagia management guidelines, and providing universal communication supports on the hospital ward.

Awareness of Patient’s Communication Method/Needs in Hospital Policy and Procedures: Promoting Communication Access

  • Hospitals might adopt SCOPE’s communication access symbol
  • Include ‘communication access’ in EQUIP (Australian Council on Healthcare Standards) achs@achs.org.au
  • Key stakeholders are given the patient experience (to change attitudes) like the ‘CEO sleepout’ campaign and action re CEO and community awareness of homelessness
  • Adapting/Adopting the US Joint Commission ‘Roadmap for Hospitals’ of the US
  • The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010.

Alert system for ‘complex communication needs’

  • Card, armband, alert system etc with client (Universal)
  • Same process as “hearing/allergy” alert for patients with complex communication needs (e.g., on chart, on patient band)
  • Visual alert for above the patient’s bed to alert that they have communication difficulties, with picture of the device / tool
  • Alert re communication impairment or AAC needs on electronic record – carry over between admissions and departments, wards etc.
Admission Information / Assessment
  • Communication screen similar to dysphagia screens in use by nurses
  • Initial assessment needs identification of key communication partner/resource.
  • Guidelines for communication management (? Similar to dysphagia management in hospitals?)
  • Patient-controlled e-health record: SLP to encourage clients to have one.
  • Community based care plans – request at admission
  • Advocating for clients with limited communication
  • Easy English rights/responsibilities
  • Engage with legal units in hospitals on this issue (esp re communication in consent, information)
  • Medicolegal focus – does patient have capacity with or without the communication aid, to give consent?
  • Include patient communication needs in nursing initial assessment
  • Routine part of nursing handover
  • Carer education, nursing education re here and now, during the admission of a patient with complex needs, coaching and modelling
  • Patient education ‘don’t leave your voice at home’
  • SLPs to ensure patients complete the patient feedback form
  • ALL of the above linked to a broader awareness and advocacy (i.e., beyond SLP)

At school – preparing for hospital

  • Collaboration between parents/carers with school staff prior to hospitalisation
  • educating peers to provide peer support
  • Community professionals being paid and supported to have links and provide info to hospital based services about the client’s communication
  • Interagency acceptance of communication supports and sharing information
  • Increased focus on communication for all patients
  • Teaching generalization skills to child in the classroom – have nurses come to the classroom.
  • Teach the child to use the system when they go to GP or school nurse/sick bay.
  • Focusing on communication needs in the school program.

Communication aids / communication supports in hospital

  • Universal communication supports on all wards – e.g., ?iPADs
  • Pictorial supports (generic universally available)
  • Communication passports for all clients – key info re communication
  • Organisation ‘Quality Assurance’ re care for clients in all settings à link to funding
  • Lines of communication with community SLP and hospital SLP
  • Developing resources
  • Staff training – senior management? Mentors? Specialists, esp re terminology.
  • make sure they have a personal communication dictionary for them, maybe with a specific tab for hospital ? can we put this on the web somehow so nurses can access it? Can we link it to e-health?
  • Hygiene – infection control – use of laminated low tech, aid placed in ziplock plastic bag/dry pack; touch screens work with covers? Gloves; pre-shower, establish communication with low tech waterproof or non-verbal unaided strategies in wet areas.
  • Communication aid – labelled with Bradma/ID sticker. Policy re who replaces/fixes it?
  • Need to be listed as a valuable to be covered by hospital insurance
  • Standard basic ward low tech kit (see several resources on the Patient Provider Communication Website, US).

I would like to thank all participants in the #ASHA2011 and #SPAconf2012 workshop discussions – each workshop contributed important insights and builds upon the strategies suggested by participants in each of the research projects undertaken to date. This information will be used to guide implementation research and the movement of findings into policy and practice to improve communication in hospital for adults with developmental disabilities and little or no speech.

Two conferences – Two continents : #ASHA2011 and #SPAconf2012 – Workshop Outcomes will be posted here

Wednesday 27th June 2012 – Speech Pathology Australia National Conference, Hobart, Tasmania.

Title: AAC Communication in Hospital: Adults with Developmental Disability and Complex Communication Needs

The aim of this workshop is to build upon the findings of recent research to develop actions pertinent to community-based and hospital-based speech pathologists in the support of adults with developmental disability who use AAC. Outcomes of the workshop will include ‘top 10 strategies’ for improving preparedness for communication to overcome several common barriers to communication in hospital.

The workshop will include presentation of the findings of recent research (15 minutes), small group discussions of groups considering either pre-hospital or in-hospital actions that might be taken to improve communication (30 minutes), large group development of policy, practice and procedural strategies to improve communication for this vulnerable group in hospital (30 minutes), and directions for future research and training to empower clinicians in all settings towards removing environmental barriers to communication in hospital (15 minutes).

Results of previous research will be integrated with the clinical experiences of workshop participants to build ‘evidence based policy’ and practice in supporting adults with developmental disability who use AAC. The results of this workshop will be published and available freely online for the future use by clinicians who seek to improve communication in hospital for adults with developmental disability.

We expect that clinicians in both hospital and community settings will contribute valuable insights on the clinical implications of our program of research exploring barriers to and strategies for better communication in hospital. Participants will have an increased understanding of the evidence base and directions for future practice and policy that might improve hospital experiences for many patients in hospital who struggle to communicate.

Notes from #ASHA2011

BEFORE hospital: communication inventory, gesture communication, create generic tools, contact with healthcare team member, referral to SLP department at hospital, priority pre-admission interview, provide parents with advocacy info, call ahead of time, students can make procedure boards and pictures, creating medical communication ‘passport’.

IN hospital: creating communication boards, use of visuals, nursing staff being a bridge to communication, having contact numbers for SLP in the community, knowing about triggers to upset/behaviour/stimulation, use of schedules, issue of handover, safety, interests, topics, regulating activities, small communication aids.

ENVIRONMENT: audits, checklists, implmentation science, training others on Standards, electronic medical record, communication as a competency, having ‘champions’ in the system.

Ideas coming from Twitter for Apps for Interaction with Adults

I asked the Twitterverse for the names of apps as ideas for inclusion in our ‘Communication Enrichment in Aphasia’ research project, run through the Communication Disability Centre at the University of Queensland. This is the resulting list! I cannot comment on any of the apps, I am just putting it here in case others want to see the responses in one place. Thanks for all of the contributors, especially @tactustherapy and @therabees who ran hot on ideas at the same time: (Apologies if the names/spelling of apps is incorrect – inclusion is not endorsement). Also, contact me if you can think of any others! Inclusion on this list does not indicate inclusion in our research – it’s just a list.


Bejeweled, Where’s My Water, Cut the Rope Experiments
TicTacToe, Checkers, Connect4, SimonSays, TaptheFrog, PaperToss, FruitNinja, MatrixGame, Chess, Solitaire 
http://www.tactustherapy.com/other.html lists of apps
Logo Quiz
Word Games, look for word searches, 7 Little Words, Chictionary, DoodleFind, Word Shaker, DrawSomething, Scrabble
Language: MyPlayHome, More Grillin’, CookieDoodle, Conversation Cards, You’re Only Old Once, Video Time Machine
2-player: Awesome Memory, Air Hockey, Bag Game, Hangman, as well as others mentioned.


footy flick, retro pinball, pipe roll, labyrinth, star walk, google earth, RTA NSW, ABC (podcasts etc), SMH online, Saving yellow
line birds, office jerk and Spark- great for conversation starters:)
sticky notes too! And I use weather from SMH

Aphasia therapy apps



Hospital staff views on communication in hospital (Children with Cerebral Palsy)

Speech Pathology Australia National Conference 24-27 June 2012

Hospital staff views on communicating with children with cerebral palsy and complex communication needs in hospital: Environmental barriers and solutions to improve communication.

Kathleen Munro (1), Nadeera Seedat (2), Kaely Bastock (3), Bronwyn Hemsley (1,3)

(1) The University of Queensland, (2) Cerebral Palsy League, QLD, (3) The University of Newcastle, Australia

The aims of this focus group study were to investigate the views of hospital staff on (a) the communication needs and methods of children with cerebral palsy (CP) and complex communication needs (CCN) in hospital, (b) their roles in supporting these children, and (c) barriers to and strategies for better communication on the ward. Participants included allied health professionals and nurses who had worked with children with CP and CCN. There was agreement across the data that children with CP and CCN in hospital need to communicate basic needs and preferences for leisure activities. Most participants reported relying upon parents to communicate with the child. Although allied health staff considered parents would be present at most times, nurses reported that this did not always occur. Barriers to the child’s use of augmentative and alternative communication (AAC) systems included lack of space at the bedside, lack of a means to store and protect a costly AAC system, and lack of staff confidence and knowledge in how the child communicated outside the hospital. One focus group of nurses reflected that barriers to the use of AAC had been removed in order to enable children to use their own AAC systems. This group reported that simple and complex high technology AAC systems were viable for use in hospital wards if environmental supports are in place. In this paper, barriers to and strategies for better communication in hospital will be presented and policy and practice implications for hospital staff discussed.

Communication Disability and Adverse Events in Hospital: Aphasia (Pilot Study)

Conference abstract accepted:

Speech Pathology Australia National Conference, Hobart, 24-27 June 2012

Adverse events in hospital as reported by adults with aphasia and their spouses: A pilot study.

Maryanne Wernincke (1), Linda Worrall (1), Bronwyn Hemsley (2)

(1) The University of Queensland; (2) The University of Newcastle


Adults with communication disability have a three-fold increased risk for preventable and multiple adverse events in hospital (Bartlett et al., 2008). However, little is known about the patient safety incidents of adults with aphasia. Saxena, Ng, Yong, Fong, and Gerald (2006) found that stroke patients often experience preventable and harmful patient safety incidents, including falls and skin sores, during hospitalization. Increased duration of stay in hospital is associated with an increased risk of patient safety incidents (Andrews et al., 1997) and stroke patients who have increased duration of stay in hospital or who suffer a patient safety incident in hospital are at a higher risk of rehospitalisation (Lin, Chang, and Tseng 2011). To date, there is little information available on the experiences of adults with aphasia relating to adverse events in hospital. The aims of the study are to (a) describe the experiences of adults with aphasia secondary to stroke and their carers/family members in relation to patient safety incidents experienced in hospital since stroke, (b) identify the situations, people, events, and outcomes relevant to the patient safety incident, and (c) look for commonalities in stories of experiences that would inform the prevention or better management of patient safety in stroke patients with aphasia.