The Monday Memo
February 4th, 2019 PITT DPT STUDENTS
Communication with Patients who use a Communication Device
Recent advances in assistive technology have transformed the way that people live, work, and communicate. For example, people who communicate verbally but have difficulty with fine motor tasks can utilize dictation (voice to text) software to send text messages or perform other functions on their phones and computers. On the other hand, a variety of communication devices exist that people with disabilities can use to produce an auditory message. These devices can be controlled with a touch screen and stylus, buttons, switches, and eye tracking/eye gaze technology. One company that produces these devices, Tobii Dynavox, is actually headquartered in the Southside of Pittsburgh.
For the past two years, I have worked as a personal care aide for a man named Mark who has Cerebral Palsy. Mark uses a Tobii Dynavox device that is mounted to his wheelchair to communicate verbally. He uses a switch that he controls with his head to create messages on his Dynavox. He also has a device that syncs his Dynavox and computer called an AccessIT. The AccessIT transfers messages from his Dynavox to the computer and permits him to control the computer mouse with buttons on his Dynavox, facilitating him while writing emails, typing essays, and posting on Facebook. Mark is pictured below when we went to the National Council on Independent Living Conference in Washington DC.
You can see Mark’s Dynavox mounted in front and the yellow switch located next to his head that he uses to control the screen.
During my time working with Mark, I have learned a lot about communication device etiquette and inappropriate behaviors when communicating with someone who uses a communication device. People are often hesitant to engage in conversation with someone who uses a communication device. However, these individuals have likely endured hours of training on their device and have it because they want to engage in conversation! Please don’t shy away from the opportunity if one presents itself. Additionally, when I am out with Mark, I often find people staring at me to answer questions that should be answered by Mark. If you are interacting with someone with a communication device, that is who your focus should be on. The aide or family member that is present will often know when to add to the conversation if it’s necessary. The last habit that I frequently observe is when people do not allow adequate time to allow Mark to respond. For example, they will ask him a question and as he is halfway through typing his response, they will ask a completely different question, forcing him to erase what he had previously written and start over. It is extremely important to be patient and allow the person time to formulate their responses! In a group situation, conversations are often fast paced. If you are working with someone who uses a device, it is okay to inform others that the person is working on a response. Therefore, the others present will remember to slow down and allow time for the person to contribute.
Lastly, I wanted to touch on some possible clinical situations that we may encounter as SPTs. When working with a person like Mark, whose communication device is mounted to his wheelchair, it is not always possible for the person to have access to their device during the therapy session. As PTs, we often transfer patients out of their wheelchairs onto mat tables or to stand and ambulate. In these situations, it is important to have a different method of communication. For example, Mark uses blinking to indicate answers to questions I ask him. He will blink once to indicate “no” and twice to indicate “yes.” If I transfer Mark out of his chair, I can ask him yes or no questions to ensure that his needs are met and he will blink in response. Some people may have a sheet of paper prepared that they can use to point to specific words. This method is good for situations when a person is in a certain position and cannot hold their device, like laying on a mat table.
Assistive technology has benefited the lives of many people and continues to grow as a field. With the increased prevalence of its usage, it is important to remember proper etiquette and how to be creative in situations when it may not be readily available to use. I am extremely grateful for my experiences with Mark and all that he has taught me. As always, Hail to Pitt!
-Niki Mikologic, SPT
**Mark’s name and picture have been shared with permission