Helping the person who is non-speaking

Have you interacted with someone who cannot use verbal communication? Do you recall Steven Hawking utilizing a computer to speak his messages on the show “Big Bang Theory”? Steve Gleason, a former player of the New Orleans Saints, utilizes an AAC device to make speeches, tell his children and wife how much he loves them, and advocate for others.

Approximately 2 million people in the U.S. are non-speaking and utilize some form of augmentative and/or alternative communication, also known as AAC. AAC is defined by the American Speech-Language-Hearing Association (ASHA) as an area of clinical practice that supplements or compensates for impairments in speech-language production and/ or comprehension, including spoken and written modes of communication. AAC falls under the broader umbrella of assistive technology, or the use of any equipment, tool, or strategy to improve functional daily living in individuals with disabilities or limitations.

AAC uses a variety of techniques and tools to help the individual express their wants, needs, feelings and ideas, including the following: manual signs, gestures, finger spelling, tangible objects, line drawing, picture communication boards, wallets, letter boards and Speech Generative Devices (SGDs) utilizing digital and synthesized speech.

AAC is augmentative when used to supplement existing speech, alternative when used in place of speech that is absent or nonfunctional, or temporary, as when used by patients postoperatively in an intensive care setting.

Helen, age 82, has had a stroke. She has a condition known as aphasia. Aphasia is an acquired neurogenic language disorder resulting from a brain injury. In some cases, people with aphasia can have severe expressive language disorders, leaving them non-speaking. Helen needs an AAC communication board to help her when talking to her family, the nurses, staff and therapists at the Skilled Nursing Facility (SNF).

John, age 58, is diagnosed with Amyotrophic Lateral Sclerosis (ALS), which will result in the gradual loss of his ability to be understood by others. He utilizes an SGD to communicate with his family. His SGD has several “banked voice” messages. He created the message “bank” during the earlier phases of his disease when his speech was clearer, and he can now use it when needed.

James, age 42, has a Traumatic Brain Injury (TBI) that left him with limited ability to speak and be understood by others. He now uses an SGD at his work. He is married with small children. He uses an SGD device to help his children with homework.

Bella, age 72, has dementia and uses a communication book full of pictures with family, friends and caregivers to communicate her wants and needs at home. The use of AAC helps her with keeping her thoughts organized and recalled when necessary.

Communication partners include family members, co-workers, friends, and acquaintances. Here are some strategies that communication partners can use when interacting with someone using AAC.

• Be patient and pause. Users of AAC have many wonderful things to share, but usually need extra time when constructing and responding to messages.

• Presume competence of the user. Assume that the person has many thoughts and needs to communicate and be open to them, doing it in diverse ways.

• Not all users of AAC rely on technology. Some utilize gestures, facial expressions and light-tech communication boards with alphabet and/or picture symbols.

• Communication is a fundamental human right. Many people using AAC encounter several types of barriers: policy, attitudes and environments. They benefit from our support of how AAC can change their lives.

If you would like to know more about AAC or know someone who might benefit from it, please get in touch with the Mollie E. Webb Speech and åHearing Center, LSU Health-Shreveport at 318.813.4200.

David Irwin, Ph.D., CCC-SLP, professor, communication disorders, School of Allied Health Professions, LSU Health at Shreveport, david.irwin@lsuhs.edu.