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Sally-Ann Garrett

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The Need for Augmentative and Alternative Communication

Posted: 05/09/2012 00:00

Imagine being locked away in the prison of your own body, unable to express your simplest needs or feelings. This painful reality can happen because of neuro-developmental disorders such as cerebral palsy and Rett Syndrome, or acquired conditions, like stroke and motor neurone disease.

While was great to see Stephen Hawking, who has MND, giving such an inspirational speech at the opening of the Paralympics, the method by which he gave his message is important too - and also sobering. Communication is what makes us human, and without the ability to communicate effectively, many people are not seen as being capable, and do not reach their potential.

Thousands of people in the UK are denied the opportunity because there is NO statutory funding for communication aids; they live without his ability to express his thoughts. Professor Hawking said, "Look at the stars, not down at your feet. Be curious". Well, I'm curious about what the government will do to support those who have a communication disability. Where is the funding for their devices?"

The recently-launched Giving Voice campaign aims to raise awareness of the problems faced by those who are unable to communicate and to campaign for funding so that all these people have the resources they need. The message about Professor Hawking, posted to the "Giving Voice" page on FaceBook received 27 shares - apparently the most for any topic ever on that page, and generated 96 likes within 24 hours.

It also stimulated people to write individual comments like this one from Fern, who wrote: "I am fortunate enough to work for a charity in NZ where the Ministry of Health funds almost all communication systems providing the client has been through a thorough assessment process. In the current age of technology where AAC systems no longer have to cost £5000 or more, it is a real shame that clients who are non-verbal do not have the means to communicate and meet their potential. Communication aids are as important to my clients as other assistive technologies such as wheelchairs or walking frames."

Alternative and Augmentative Communication is the key to helping people who cannot communicate using their own speech and voice, but the debate is not only about the funding for AAC, but also about the information on AAC that is taught to students during their formative years in university. The debate should start there, and include questions like these:

How many Speech and Language Therapists graduate with sufficient knowledge and understanding of the needs of people who are unable to use their own speech and voice to communicate?

What opportunities are there for student placements where AAC is used?

Does the current curriculum cover the theoretical aspects of AAC in sufficient detail?

Once qualified, what support is there for newly qualified Therapists to develop the specialist skills required to assess and prescribe for AAC, especially high tech devices?

The issues of funding come after that, because if Speech and Language Therapists don't prescribe the devices, then the government does not know what the need is, and funding won't be provided.

The current system is mainly dependent on individual Speech and Language Therapists to assess and prescribe, sometime through special centres for AAC such as the Assessment and Outreach Centre for the South West, where a flexible assessment service, including home visits, is offered to people of all ages throughout the region. They have a bank of AAC devices which they can provide for trial, offering training to get the most from them.

Chris Freestone, head of children's services at the Dame Hannah Roger's Trust, Ivybridge, wrote, "I passionately believe that every child deserves to be able to communicate in order to make choices. It underpins everything we do." This also applies to adults.

Communication aids range from something as basic as teaching the person how to sign, to equipping them with the latest and most sophisticated computerised equipment that might cost many thousands of pounds. Some of the latest software available for use with an iPad is even free, or can cost as little as £1,000, while other devices can be £15,000 or more. But how can you put a price on a person's ability to communicate effectively with family, friends and loved ones, and to participate in society and use social networks?

Chris went on to say, "It is brilliant that we have been able to help a person with locked in syndrome to articulate what he is thinking again. It opens up all sorts of opportunities for him to be able to express what he is feeling."

The 1998 Human Rights Act recognises that communication is not a luxury but an essential life skill, yet in the present economic climate funding for such a right can be a political minefield. Sadly it can all come down to where you live; a recent Scope report found that health and education authorities often pass the buck between one another when it comes to funding, with some even restricting usage and removing the devices out of term time.

Funding is hugely important - I hear all too often from parents that the recommendations for devices are not made because "the funding won't be available". Surely Speech and Language Therapists need to believe in the strength of their convictions and prescribe the right devices, and educate Commissioners in Health and Education to understand that the devices need to be funded from central sources, not charities or personal fund raising?

 

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Imagine being locked away in the prison of your own body, unable to express your simplest needs or feelings. This painful reality can happen because of neuro-developmental disorders such as cerebral p...
Imagine being locked away in the prison of your own body, unable to express your simplest needs or feelings. This painful reality can happen because of neuro-developmental disorders such as cerebral p...
 
 
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06:08 PM on 09/05/2012
Therapists should KNOW their patients. If they have use of their hands, sign language is great, however, it's limited to only those few others who know it. It should be a required "language" in schools for a start. However, my biggest issue is cost. In the US, Eyegaze technology costs a minimum of $7,250 if you have a properly equipped laptop or PC already and, of course, the cost only goes up from there. People around the world NEED this equipment. I haven't delved into the specifics as to what all is involved, and I'm not all that technology minded so I probably wouldn't understand if I tried, but in the age of technology, why isn't it more affordable? We wouldn't need funding/charities if they could produce this type of technology at a more affordable cost. Are these systems built "as ordered" and that's why they're so expensive? Why not mass produce? Are there certain components in them (gold or other precious metals) that is what jacks the price up? Couldn't those producing them find another metal to use that's just as good? I'd love to know exactly WHY are they so expensive when we can now find other (often unnecessary) computer components for a few dollars, but things so many need are out of almost everyone's price range. It makes no sense to me.
11:14 AM on 09/05/2012
Part 3 (sorry, but HP won't let me post a longer comment all in one):

I would love to do this for people. My impetus for studying speech therapy was a delightful woman I worked with at a charity. She has cerebral palsy and her only way to comment was to have an assistant help her laboriously spell from an alphabet chart. I was sure there would be a better way for her to communicate. She is surely not the only one with this dilemma.

Now I'm a qualified speech and language therapist and would love to work with high tech AAC, but there is no one to hire me, and even the AAC companies themselves are shedding jobs. How can we learn more and use our skills to help if no one wants us?
11:13 AM on 09/05/2012
Part 2:

One of my fellow students had a one day a week placement, for 15 weeks, at this AAC unit, but the unit has had its funding and staff cut so much that they are not able to offer more. The remaining two clinicians are available to contact for advice on some days. I am a member of an AAC Specific Interest Group which provides current usage information and is helpful to keep my knowledge up.

The biggest problem is that there are very, very few entry level jobs for newly qualified SLTs. I was a mature student, with a family and home, and cannot move to take a job. At present in my area (the Midlands) there are exactly zero entry level jobs that I could apply for. Indeed, my own final 15 week placement had to be changed at the last minute because the trust I was assigned to fired half their SLT staff and dispersed the rest through the trust. There was no one to supervise me.

We are discouraged by our own professional body from setting up our own practices as newly qualified therapists. There are few entry level positions in the NHS. But the need is huge and we are keen to use our knowledge and learn more. IEven with a "mainstream" device such an a iPad, an expert in communication is needed to assure that the device is being used to its best advantage.
11:13 AM on 09/05/2012
Part 1:
Thank you for an interesting article on an important theme. In answer to some of your questions: I'm a newly graduated Speech and Language Therapist. As part of our course we spent a day at a specialist AAC unit, which gave us an overview of the equipment available, the chance to try it out with each other, and the opportunity to talk with an AAC user. That was the extent of our course experience. I wrote my final dissertation on an AAC theme, and it was quite difficult to come up with a lot relevant research to discuss. There is work here to be done.