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>>> Welcome, everyone, to the
Making Connections webinar
series, presented by Seniors
Health Knowledge Network.
My name is Lindsay Toth, and I
am the technology and admin
manager at SHKN.
Before we begin I am going to
give you a quick rundown on the
technology for today's webinar.
The audio is provided through
your telephone conference line.
The presentation slides are
provided through a web platform
called Level 3.
We are very happy to be
providing a live captioning
service today, as well.
The captioning service also runs
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This means that if you would
like to take advantage of the
captioning, you will need to
have two windows open
simultaneously on your screen.
One for the captioning, and one
to see the slides via Level 3.
The phone number for the
conference line and the links
for Level 3 and the captioning
service were sent to you by
email after you registered for
the webinar.
If you have questions about the
technology at any time during
this presentation, please type
them into the chat box.
Located on the left-hand side of
the screen.
Alternatively, you can send me
an email to
ltoth@seniorshealthknowledgenetw
ork.com.
I will work to resolve technical
issues as soon as possible.
This webinar contains an
opportunity for participation
during a discussion period at
the end of the presentation.
If you have topic related
questions during the
presentation, please type them
into the chat box.
The knowledge broker, whom I
will introduce shortly, will
read the questions aloud to the
group.
If you would prefer to ask your
question over the phone, you may
unmute your line by dialing a
star, seven.
When you are finished we'll ask
you dial star, 6 to remute the
line.
Right now, everyone is muted
except for me, and this is to
reduce background noise.
I would like to introduce a
knowledge broker with the
network and the facilitator for
the webinar.
>> Welcome.
Before we get started, some of
you may be wondering what the
health knowledge network is
about.
SHKN makes connections.
We link people, resources and
ideas together to benefit the
health of the aging population.
Our mission is to make a
positive impact on seniors
health by encouraging
advancements in education
practices and policies.
The Making Connections webinar
series is a way that we are
sharing knowledge, ideas, and
best practices to help improve
seniors' health in Ontario.
We support nine communities of
practice, including aging and
developmental disabilities,
communicative access and
Aphasia, and diabetes,
medication safety, nutrition,
wealth, mental health addiction
and is behavioral issues.
We collaborated with other
networks, including Alzheimer's
Disease knowledge exchange in
the Ontario research coalition
to support the CoP.
Our network provides library
services including access to an
information specialist who can
provide evidence-based
information to professional
health care givers in Ontario.
We are generously supported from
the funding of ministry of
health and long-term care, for
more information about the
network and to join one or more
of our communities of practice,
visit
seniorshealthknowledgenetwork.ca
, and you will find resources on
our website, and you can visit
our events section as we are
holding two webinars a week from
now until March 2014.
Our event section also has a
list of upcoming conferences.
So today's webinar is about
supportive conversation for
adults with Aphasia.
An introduction to essential
supported conversation skills.
Elyse Shumway is a speech
language pathologist with
additional post-graduate
training in instructional design
and educational technology.
She's affiliated with the
Aphasia institute where she
assists with the delivery of
training programs and pictograph
resource materials.
She also maintains a private
practice specializing in
community-based rehab.
So, with that I will hand it
over to you, Elyse.
>> Why, thank you very much.
It's a pleasure to be here, and
I am so pleased to have so many
people on the line.
Can you all hear me fine?
I guess if you cannot hear me
you will let me know.
So, as it's been introduced,
today is an introduction to
supported conversation, which is
a technique to help you learn
how to, to improve communicative
access to your health care
services.
I'll mention a bit about our
community of access.
We are the community of Aphasia,
and we are supporting health
care professionals, researcher
and policymakers who are working
to improve access information
and decision-making for anyone
who knows more than they can
say.
And that includes anyone with a
speech or a language disability.
Supported conversation is a way
to increase communicative access
to your health care services,
and as we all know,
communication is an essential
element in health care delivery.
Anyone who knows more than he or
she can say, has reduced access
to health care at community
services by nature of their
communication disorder or
difficulty.
This includes anyone with
Aphasia, which I will be
describing in detail in a few
minutes, or motor speech source,
which is anybody with a
difficulty in actually producing
the, the muscle movements to
make speech.
Certainly dementia has a
communicative access component,
and hearing loss does as well.
And anyone who doesn't speak the
English or the dominant language
of a particular environment also
has a communication challenge.
It's not a disorder but it does
qualify as a communication
challenge.
So, as I mentioned, supported
conversation is a way to, to
increase communicative access
for anyone who has any kind of
communicative disorder.
Let me just explain a bit about,
about how this works, and how,
how supported conversation can
help you improve your access to
your, your services for anyone
who has a communication
disability.
And Aphasia, is a problem with
language, and so it has --
anyone with Aphasia has
difficulty understanding
information, getting information
in, expressing themselves,
getting information out, and
then you have to verify what you
are trying to, to exchange as
far as information.
With hearing loss, there is
clearly a problem getting
information in, but getting
information out is no problem.
With motor speech disorders,
they have problems getting
information out, but if there is
only a motor speech disorder
they will understand what you
are saying so information in is
not a problem.
Cognitive communication
disorders, that includes
anybody with dementia or
traumatic brain injury, for
example, they also have problems
getting information in and
getting information out, and you
will have to verify that they
understood you well.
And the same goes for anybody
who has problems with English as
a second language or as I
mentioned, anybody who has
problems communicating in the
dominant language of a
particular environment.
Now, supportive conversation is,
is a technique that we have
developed at the Aphasia
institute.
We have trained many, many
people over 20 years to use a
particular technique, and its
evidence-based now, so we know
that, that this is one, one
really good way to, to improve
communicative access, and what
you do is by training your
service providers on how to use
special communication
techniques, you are changing
the, the elements of the
communication environment, and
you are creating what is,
essentially, a communication
ramp.
You are insuring that an
individual is able to be
included on important
conversations and
decision-making events such as
case conferences or bed-side
decision-making, by, by training
your, your service providers to
communicate differently.
The, the supportive conversation
framework is an approach that
prompts the care provider to do
two primary things.
One is acknowledge competent,
help the person feel as though
they are being treated
respectfully by changing how you
interact, and by revealing
confidence, getting and giving
accurate information via your
information in, helping the
individual get their information
out and verifying that you have
exchanged the correct
information.
Now, let's talk a bit about
acknowledging confidence.
That's the, the primary, most
important feature of the
supported conversation is
starting by creating a good
platform, and a good way to
acknowledge somebody's feeling
they are being heard and
understood.
There are two ways to do that.
One by indirectly
acknowledging the confidence of
the individual and then by
explicitly acknowledging that
competence.
First, by your tone of voice,
your eye contact, facial
expression, body posture,
appropriate touch, say on the
hand or foreman, is considered
appropriate in our culture.
Making sure that they know that
you are there for them, you are
willing to do what it takes to
understand them by non verbally
acknowledging that you know that
they are competent and they know
more than they can say, and
verbally by using appropriate
vocabulary.
Using humor.
During break do you knows to
your own communications, I'm
just having a bad day.
I am trying my best.
Let's try that again.
Making sure that they know that
you are really trying to
understand them.
And by explicitly acknowledging
their competence, you are
allaying their frustrations and
fears that they may be thinking
that you don't know that they
are intelligent, they are
confident, and you indicate that
by saying I know you know, and I
know that I'm trying my best to
understand you.
And then dealing openly with
situations in which you have to
obtain information, maybe, maybe
from a family member or a
friend, and you indicate that.
If I had the time, if I had the
resources, I would have more
time, but is it ok if I ask your
spouse, and ask your friend, to
help me a bit.
And that way, you are
acknowledging their competence,
and you are moving along in
terms of time or, perhaps,
reality by asking a friend, but
you know that they understand
it's not because you don't think
that they could tell you if you
had enough time or resources.
And then revealing competence.
Now, we're trying to get and
give accurate information.
So you are going to try
techniques for getting your,
your message into the person,
and helping them to get their
information out, and verifying
that you have, actually, got the
correct information.
Now, information in, as I
mentioned, people with Aphasia
or a language comprehension
problem or a hearing loss,
strictly a sensory problem, have
difficulty understanding what
you are saying.
Not because they don't
conceptually understand it, but
because either the hearing is
not good enough or their ability
to decode the language is not
good enough.
So, what you are going to be
doing is speaking, using short,
simple, grammatically correct
adult language, but short and
simple.
You are going to use gestures
to, to enhance the
comprehension, so, for example,
gestures easily understood, and,
you know, raising your hand,
showing that you are taking a
drink is a good example of an
iconic, easily understood
gesture, and you are also going
to write key words on a piece of
paper as you speak them in
large, bold print.
So, you are giving them an
additional chance of, of reading
the word, another way to get
over the language barrier, and
if you have photographed, if you
have illustrations, if you have
objects, that you can point to
or use or have somebody touch,
even, that's another way to get
the message in by, by focusing
on the main topic.
So you are trying to overcome
the language or the perceptual
barrier by using additional
information to get your, your
message in.
If you have the time, you may
also want to make sure that,
that they are able to get their
message out.
Now, somebody who has an
expressive language, or
expressive speech problem, may
not be able to actually say what
is on their mind.
They have to, to get their
message out in a different way.
One of the best ways is by, by
responding to yes, no questions.
So, you want to make sure that
initially, that there is a, a
valid, reliable way for them to
express yes, no.
Someone with Aphasia sometimes
will say no when they mean yes.
And this is not confusion.
This is a language problem.
So, you will want an alternative
way for them to indicate yes/no.
You may find the head nod is
reliable.
Eye blink.
Facial expression.
Possibly.
You may also write down yes/no
and question mark on a piece of
paper and ask them to point to
yes or no as another way that
they can read and point, that's
a way to indicate yes, no.
Thumb's up, thumb's down,
another gesture.
Some I understand could have way
that you have tested to make
sure that yes, no is reliable.
Then you can ask yes, no
questions, and it, you can be
amazed at the information you
can get by using well crafted
yes, no.
The first thing is to ask one
thing at a time so it's not do
you want coffee or tea, it's
would you like a drink.
Would you like coffee.
One thing at a time.
Yes, no.
And then you can, actually, ask
them to give clues by gesturing
or pointing, indicating pointing
to written key words, can you
show me some way for them to
indicate a choice, a multiple
choice possibility.
If you think that they can,
actually, select among more than
one option, or you can stick
with the yes, no.
The main thing is, it gives a
person enough time to respond,
and make sure that you have a
reliable yes, no, and start to
actually craft your yes, no with
the big questions first, the big
ideas, and then, and then slowly
whittling down to, to yes, no
questions.
And then, once you have done all
of this, you have to verify.
As you will find, you will be
doing a lot of educated guessing
when you are asking yes, no
questions, and you may,
inadvertently get off on the
wrong track.
And your person with Aphasia may
not have a second to stop you
and indicate you are on the
wrong stop, so you have to stop
every so often and make sure
that you have clearly
understood, so you will
summarize slowly and clearly.
Give them plenty of chances to
indicate that's not the right
idea.
So let me make sure I
understand, you said, you will
be going home on the weekend.
Your son is coming to pick you
up.
You will be coming back on
Sunday night, and every so often
you make sure that you have
understood correctly and give
lots of chances for them to
correct or say no, that's not
quite right.
You will be using your written
key words, your gestures and
pictograph images and
photographs to reflect and
expand and then summarize again.
And once you have done all of
this, you will have a large
record of written key words that
you can, actually, leave behind
for someone else to have that
same conversation.
As you might imagine, most of us
can talk about, about
conversations that we have had
with other people and, and
indicate, I talked to so and so
on the weekend, and they told me
about their trip to Florida
where they went, with the kids,
and someone with Aphasia or
another communication problem
really can't talk about a past
conversation the way that we
can, but if they have all your
written key words, and all your
summaries, on paper, if you
leave those behind, that's a
great tool for them to show
somebody else to indicate they
would like to talk about that
again, or tell somebody that you
had this really wonderful
conversation.
It's important, it's an
important resource, for sure.
Now, I mentioned pictographs,
pictographic resources.
We at the Aphasia institute have
over 10,000 illustrations that
we have developed over the
years.
Quite soon they are going to be
available online.
Watch for, for our Aphasia.ca
website in the coming months and
you will see there is a new way
to access these resource says.
Many of them are available for
free for those in Ontario, the
resources that have been funded
through the ministry of health,
and I will describe those in a
minute, but they are also
available, you can have a look
to see what you think might be
helpful for all kinds of
conversations.
These are graphic images that
communicate meaning.
And they are adult in nature,
and they fall into the category
of illustrations.
We, actually, have three types
of them.
We have objects, actions, and we
have metaphor, and the metaphors
are probably the most useful
when you are trying to
communicate something that's
complex as you might imagine.
People with Aphasia have the
same ideas, the same
sophisticated concepts, but it's
hard to communicate that with
just simple objects and actions.
We also have metaphors, as well.
We have used all the people that
we have interacted with over the
years who lived with Aphasia to
help us determine what kinds of,
of concepts they need to
communicate.
And we have used those to help,
help us design our pictographs.
Just for an example, I show you
now some, some very simple
examples, and these would be,
would be objects and actions.
So, medications and injections
and changing bandages, and those
are simple objects and actions.
And another example would be
activities of daily living.
We have a whole resource for
occupational therapists and
nurses.
Making change, paying bills,
budgeting, and banking, and
these are another example of, of
simple objects and actions.
And many years ago we were asked
to take the residents' Bill of
Rights in long-term care and,
and, in Ontario, homes,
long-term care homes, and
translate that into, into a
pictograph resource.
We took a few essential elements
and put them on a poster, and
many of the long-term care homes
do have this posted.
It's not obligatory but an
option.
And you can still download there
for free from our website if you
would like to have it in your
environment.
This gives an example of how we
used pictographic images to
convey a little more complex
images, so you will see the case
conference table.
You will see privacy images on
the right.
These are ways to look at, at
more complex concepts, and this
would be a, a way to open the
conversation.
It's not meant to convey, you
know, the whole concept, but, to
give an idea that you might want
to talk about some kind of issue
in your environment that has to
do with rights.
This is an example of, of a
pictographic image that would be
used to, to convey questioning
around a transit scheme of
attack.
So, did somebody have, have a,
a, a couple of symptoms that
might preclude, or might, might
present prior to a stroke?
So if they had difficulty
walking, and they had some
sensory difficulty, they had
difficulty swallowing,
dizziness, and some visual or,
or speaking difficulties, this
would be a way to ask about how
this happened in the past, and
without this resource, it's very
hard.
You might want to gesture
something, you might want to
pantomime, even, but that would
be in addition to using this
kind of visual image.
Now, I apologize, excuse me,
this is a bit vague.
But, this is an example of what
we know by metaphor.
On the left you have car and
driving.
On the right, is, is a, an image
from, from a, an assessment
where we're asking somebody, are
you in charge of your life?
Now, that was a really hard
image to, to try to convey.
The idea was, are they
independent, are they making
decisions.
And we, actually, used somebody
in the driver's seat to show
that, that they are in charge of
their life.
Are you in charge?
And, and that would not go --
knolled not stand alone, and
this also illustrates how the
images are meant to be used
inside of a conversation.
They are not plenty to stand
alone.
So, you use the image, and then
you explain it, and you might
write additional key words, you
might add more gesture on your
own.
They are meant to support the
conversation.
And, and not be a resource for
strictly for pointing.
And then at the bottom, it's
hard to see, but, there is also
a scale.
Where you have somebody on the
left, it's the dark color.
There is a thumb's down, and on
the right, it's a light color, a
thumb's up.
And that's meant to be a, a
decision-making scale, yes or no
or somewhere in between.
So, that shows you how we use
these various images as part of
our support for the
conversation.
So, in summary, as I mentioned,
these pictographs are not meant
to stand alone.
They are always used in
combination with speech and
intonation cues, with gesture
and writing, and the goal is the
person with Aphasia to engage in
conversation.
So they are used as visual
references, and actually the
person with Aphasia or other
communication problem can,
actually, search through and
pull out the picture and show
them to you again to reintroduce
an old concept.
So, now, I mentioned that some
of our resources are free and
this is the series that you will
-- if you are living in Ontario
and, and you have, you have a
postal code, you can go on our
website and download the
resources that are on these
topics.
Abuse, arthritis, diabetes,
being discharged to go home,
hearing loss, heart disease,
oral care, osteoporosis, heart
disease falls.
Medication management, not
mediation management, we should
say, recreation and leisure and
death and grieving and
continence and these are meant
to be used for any of you doing
patient education on these
topics or you are preparing one
of your patients or clients to,
to have an interaction with
their health care practitioner,
that's the purpose of these,
these resources.
They have specialized
illustrations for topics for,
for, for images for, for actions
and, and anything that has to do
with the topics.
So, please feel free to have a
look.
So, as I mentioned now, we've
been talking so far about, about
transaction primarily, which is
the idea that when you are in --
a transaction is, is a, a, an
exchange of actual information.
So somebody, you need to have
the actual accurate information
in terms of the health care
conversation or anything where,
where the accuracy is paramount.
Now, with Aphasia you might have
to, to work on in and out, and
verify because there is a
problem understanding, there is
a problem expressing, and then
you have to verify.
Again, with hearing loss, the
only problem is getting the
information in, with motor
speech disorders, that's a
problem, actually, making the
muscle movements for speech,
which you will see in Parkinsons
disease and Multiple Sclerosis
and any problem with motor
speech, and the only problem is
getting the information out.
Understanding is ok.
Now, with cognitive
communication disorders,
dementia, traumatic brain injury
you have problems in and out,
and the same goes for English
and a second language.
Now, we're going to start and
talk more about interaction.
When you think of interaction,
that's more the social, the, the
emotional aspect of
communication.
And with people with Aphasia,
hearing loss, and motor speech
disorders, and English as a
second language, they do very
well on the interaction side.
If, if, if it did not matter
whether the communication was
accurate, in terms of the
exchanging of information, they
would be fine.
People with Aphasia often
explain their, their situation
when they are able to
communicate that as having,
having been, been plunked down
in another country where
everyone is speaking a different
language, and they don't speak
that language.
That's the experience of
Aphasia.
And, and yet, when you can
imagine yourself in another
country, you are, your
interaction is fine, and you are
looking for non verbal cues and
you are looking for signs.
You are watching people's facial
expressions, and your
interaction is ok.
Now, with cognitive
communication disorders, I have
often been asked, how can, can
supported conversation be used
for dementia or traumatic brain
injury, and it can be used for
that purpose, but you have to
remember that, that in that, in
that -- in a cognitive
communication disorder, you also
have difficulty with
interaction.
So, not only do you have to
transact the information, but
you have to focus on the social
aspect, and that is another way
to use supportive conversation.
The conditions that result in
cognitive communication
disorders would be dementia, as
I mentioned, traumatic brain
injuries.
Also, the neurodegenerative
conditions like Parkinson's and
Multiple Sclerosis as they
progress down the road, you
start to develop the cognitive
problems, as well.
And then you have more of a
cognitive communication
disorder.
With stroke, if you have
multiple infarct, or non
dominant hemisphere or
subcortical strokes, you have
cognitive problems, and with
infections, encephalitis,
meningitis, those difficulties
or, or, you know, drug
overdoses, subcortical symptoms,
you will have problems, as well.
>>> The problems with cognitive
problems and how that interferes
with conversation include
reduced attention and
concentration, that's a common
cognitive problem.
Also, reduced vision and/or
hearing so the sensory
difficulties can interfere with
conversation.
And any kind of problem with
memory, and any kind.
Problem with impulse control.
You will find that you will have
a cognitive difficulty that
interferes with conversation.
Now, the problem with, with
interaction, as a social and
emotional engagement, when you
have difficulty with
concentration, you have problems
maintaining a shared topic of
focus, and you also have
problems taking turns and
speaking and listening.
So, if somebody has difficulty
in maintaining a shared topic
focus, their mind will wander
off of the conversation, and
that's, that's with the
attention and concentration
difficulty.
Then they will have difficulty
engaging, and you can, actually,
use the illustrations, the
pictographic images, and the key
words to, to bring them back to
the shared topic focus.
Also, taking turns, you will
find that people who have, have
difficulty in concentration or
impulse control, they will
interrupt, and they will start
talking, talking over the other
listener, and they are not able
to listen actively, and you can,
actually, use the illustrations
to sort of say, now, I'm going
to be taking my turn now, and
you will, you will give them the
information, and let them take
their turn so you can
gesturally, using images to
engage them in the idea of
taking turns as an interaction
of focus.
Certainly with transaction, you
are exchanging accurate verbal
information, anybody with a
cognitive problem, they will
have difficulty with memory and,
and recalling what has been
said.
They have problems initiating a
topic.
And you can use the images to
show them the possible topics
that they could talk about.
And they could point to one of
them and start the topic
initiation that way.
And they might also make
inaccurate comments based on the
knowledge of the conversational
partner.
They don't always know what you
know, so, you can use the images
to show them what you would like
to talk about.
And then maintain the topic
across several comments.
You can use the images and the
key words to, to bring them back
to the topic that you've been
trying to, to have a
conversation about.
>>> In terms of the taking
turns, reducing attention and
concentration, reduced vision,
and they may not know that you
are speaking, so you might want
to, to use touch or, or some
kind of sensory input to get
them to realize that it's their
turn or your turn, and reduce
working memory will also be a
problem.
You Ma I say the same thing over
and over again, and you just
have to, have to maybe repeat
yourself.
They may not, actually, retain
what you have said, so that,
that the working memory problem
is there.
Reduce impulse control, they may
say something that, that is, is
either inappropriate or not
topic related, and you can,
actually, bring them back to the
topic by showing them the, the
images or the key words.
And encourage them to, to engage
in further turn-taking of.
So, this is what, this is our
summary image.
And the, the tool bag, the, the
black bag, if you will, that
shows the different images that,
that we, we feel is, is the most
prominent, the most useful as
far as using supportive
conversation.
The handle, again, is the
acknowledged competence, that's
what we call the golden rule,
making your patient feel good.
And we find that, that, again,
acknowledging competence by
speaking in adult tone of voice,
and using the right tone of
voice and the correct, you know,
short, simple, but accurate
language, is to help somebody
feel like you know that they
know, and even if somebody has,
has a, a cognitive communication
problem, if there are memory
problems, if there are attention
concentration problems, and it's
never damaging to acknowledge
the competence and make them
feel like you are listening, so
there is never a downside even
if the, the memory is not there,
or the decision-making is a bit
compromised, acknowledging the
competence puts you on a level
playing field and helps them
know that you are there to, to
try to understand what they are
trying to convey even if the,
the words are not accurate.
And revealing competence,
helping the American reveal what
they know.
Through, through enhancing what
they understand, and getting the
information in, and helping them
convey what they want to get,
getting the information out, and
verifying that, that you have,
actually, not been, been
incorrectly guessing, certainly
when you are asking yes, no
questions, you may, because you
are guiding the conversation and
using some educated guessing,
you may guess incorrectly, so
you really have to stop and
verify quite often, and then,
and then how would be all your
techniques.
So, the yes, no question mark,
card, make sure that you have
that, or some kind of reliable
way for a them to indicate yes,
no.
And gesture, making sure that
you use gesture, and asking for
clues, so can they show you and
can they point, can they give
you a verbal clue?
Can they give you some kind of
information that helps you guess
correctly?
And showing pictures, either our
illustrations or a photograph of
your own, you know, your own
hand drawing can be useful,
people draw stick figures, a
little house, you know, some
kind of, of way to, to bring the
person in.
You can, actually, ask them to
draw a bit if they could do it,
or they can write even the first
letter or some kind of, of a bit
of a word to, to give you a
hint.
So, you are giving hints and you
are asking them to give you
hints.
And then you write key words as
you are saying, you know,
simultaneously, you are saying a
short innocence, as I mentioned,
you are going home on, home on
the weekend, you write home.
Your son is picking you up,
write your son.
You don't write the whole thing.
You are not trying to transcribe
the sentence, but just the key
words in nice, big, bold print.
Using a pen or marker.
That's, that's kind of a summary
of all the techniques.
I must also mention that
sometimes, people who are first
learning supported conversation
think that's really, that's
obvious.
It does not sound like it's
complicated, and it really
isn't.
It's more of a, of a motor and a
conceptual skill.
So, knowing what you should do
and then actually, doing it are
two different things, and people
say it's like playing tennis or
like learning to drive.
You can read the book.
You can know all the rules.
But, until you actually start to
try it, that's when you realize
it's really a skill, as well as
a knowledge base.
So, there is a bit of a motor
learning to writing and
gesturing and, and doing all
these things as you also keep
talking, and then modifying your
language and your speech to be
different, slow, and accurate,
and short and simple, while
writing and while gesturing.
That's, actually, you know, not
so easy.
So, you know, you will take some
time to learn it.
And it will take time to
practice it.
And then, in a couple of weeks,
if you come back for the next
webinar, we'll talk about how to
use the, use these techniques in
a patient education format.
And how you might use the
conversation to make sure that
if you are educating your
patients will health care
topics, that your education is
accessible because that's,
that's very hard to, to convey
information to the individual,
who has communication difficulty
directly.
We often talk to their spouse or
their family, but the evidence
is clear unless you talk
directly to the patient, and you
are the authority you, that they
won't necessarily take the
information as well from, from
somebody else.
So, it's really important that
we try to make our patient
education as accurate as
possible.
Now, after our, our session
today, I'm going to be sending
you a link to a self directed
learning module.
And that is housed on the
Aphasia website, and it will
have information about supported
conversation included, as well
as video clips that illustrate
each one of the techniques that
I mentioned.
All the techniques for getting
your information in, and how to
get over the language barrier to
make sure somebody understands
you, and then techniques for,
for getting your information
out, ways to ask yes, no
questions, ways to use key
wording, and gesture, and ways
to, to verify accurately.
And then as well as
acknowledging competence.
All those techniques are
included on the self directed
learning module, and feel free
to use, to take a look at that,
and we suggest, if possible,
that when you do view the self
directed learning module, that
you do that in pairs.
If you possibly can because
there are many points where,
where, where you will want to
stop and, and, and, you will
have a role play suggestion, or
a discussion, suggestion, it's
really great if you have a, a
partner to do it with.
If not, you can think it through
and write your answers down
before, before you, you view the
next slide.
But, if possible, it's really
great to have a partner to do
that with.
So, that, that link is coming
after today.
This afternoon.
So now, I will suggest that you
download any pictograph
resources that you can from our
online store.
And then you browse our training
events.
What, what people often ask me,
what's the difference between
today's webinar and coming to a
training session that either is,
is given at the Aphasia
institute or by, we have a
number of speech pathologists
who have been, have been to our
sessions, that are trained,
trainers, and they are out in
the community giving SCA
workshops and learning events,
and they would be the next best
thing to coming to the Aphasia
institute for training.
As I mentioned, because
supported conversation is really
a motor skill, and it does
require, if you are really good
at it, requires a bit of
coaching face-to-face, that
would be if you were really keen
to learn how to do this a little
more expertly after you watch
ourself directed learning
module.
You watch the video clips, and
you give it a try, and if you
would like further training,
please come to our website and
look at the training events.
And as I mentioned, in two
weeks' time we'll have another
webinar that will show you how
to adapt supported conversation
to a patient education
framework.
So now, I wanted to leave quite
a bit of time.
I often find that people have a
lot of questions.
They may have some case studies
they would like to talk about or
some, some observations, so I
wanted to leave a bit of time
for questions, and I will, I
will let people go ahead and --
you want to go ahead and, and
let me know what's in the chat
window, or ask me a question,
that's fine.
>> That was great.
We do have a few minutes for
questions, as you said.
I will open it up to the
audience right now, but to get
the ball rolling, we do have a
couple of questions that came
in.
The first one was in regards to
Aphasia institute's pictographic
resources.
When and where are they
available and are they in
another language, like Mandarin
and Cantonese?
>> We have translated a number
of our resources into other
languages.
I know that -- I saw a question
about Chinese.
If they are being, they are
being translated into Chinese.
We also have Scandinavian
languages.
We certainly have French
resources.
So, yes, please, please make
contact with, with our, our, to
the Aphasia institute.
You can ask the training
coordinator, and she can let you
know about, about the other
languages that the resources
have been translated into.
And I know that they are working
on the Chinese, as well.
And Aphasia.ca, if you go there,
go to the, the online store, and
you will see all the resources,
the ones that are free, are the,
the working together series that
are about patient education, and
the others are a nominal fee
that we use for the purposes of
maintaining the resources.
>> Perfect, and we had a second
question about, about one of
your slides, the SCA, your black
bag.
>> Yes.
>> Would that be available for,
for individuals to have?
Would you be able to send that
out?
>> I will have to double-check.
If I can, I will.
I will just ask the, the
institute as far as permissions,
but I would be happy to do that
if I can.
Yeah.
>> Ok.
Perfect.
And so, again, star, seven, to
unmute yourself, if anyone else
has questions.
>> Joyce, the geriatric
assessment outreach team.
>> Yes.
>> Thanks for -- hi.
Thanks for a really interesting
presentation.
I am just wondering what your,
your experience is in terms of
the family or caregiver
reaction.
Often, when I am out in the
home, families will, will be
there.
And, and do they tend to, to
find that, that this is a
positive experience when you are
using all those tools, or do
they get frustrated in terms of
the time it takes to, to work
through an assessment.
>> were, you know what, I find
with families, one of the first
-- the best thing for them is to
realize that, that it is
difficult for them to, to
communicate, but once they
realize that, that the
competence is there, and that if
they use the techniques, they
can, actually, exchange
information, they are really so
pleasantly surprised.
So, I think, you know, the idea
with a couple of, you know,
minor changes in their
expectations, and their skills,
that they can exchange
information, they are really
delighted.
That's number one, and number
two, I think that the important
thing also is for them to
realize that, that even though
it seems, you know, you are
writing key words and using
illustrations, sometimes, people
can, can get the wrong
impression that it's, actually,
that the competence is not
there.
Right.
There is a, an element, an
elementary school sensation
about this.
And it's really important to, to
explain that that's not the
case.
So, you say, we're using
alternative ways to get around
the language barrier.
We, actually, have one
situation, it is like a brick
wall, and the brick wall is the
Aphasia, and you have to use the
techniques to get over that wall
of language disability.
And once you are over the wall,
you are in.
And once you are in, you are in,
right, you are into the area of
competence.
And, and once they understand
that idea, then, they are
willing to do what it takes.
But, it's that idea that, that
there is this barrier, and it's
a language barrier, not an
intelligence barrier.
>> Right.
Ok.
>> That, at first it's a hard
idea to, to explain, but once
they get it, they really get it,
and then they go, oh, why not,
you know.
And then we'll use illustrations
and pantomime and tap dancing if
that's what it takes, and they
are happy to do it.
>> Ok.
>> Ok.
And I just -- just before I sign
off and, and give someone else
an opportunity, in terms of the
time because we're told, of
course, that we have got to work
faster and more efficiently,
and, you know and, and you did
touch on that, but, do you find
that, that you, that, I mean, in
terms of the timing, and I
realize, I guess, it's
individually based.
Some people might, might pick up
a little faster than others,
but, have there been any, any
assessments or studies on kind
of, of like, like does your time
double doing this?
Or, or, you know, or --
>> I actually divide it into
two.
The time it takes to get the
information in, is not as long
as it takes to get the
information out.
>> Right.
>> So, I find that, that in
environments where, you know,
you are really pressed for time
like acute care or emergency or
various time and places where
time really is of the essence.
Information in is primary.
Because people often say, later,
they did not understand what was
going on.
And if you think about informed
consent, you know, there is an
obligation to do the best that
you can to get the information
in.
And later, after the initial
stroke, we'll say, I didn't know
what Aphasia was.
I didn't know that I had had a
stroke.
I didn't know that I would live
or die.
That sort of information in, I
think, is, doesn't take that
much longer.
And it's really crucial.
>> Ok.
>> And information out does take
time.
You know, it takes time to ask
questions and verify a yes, no
response, and certainly, you
cannot say it does not take
time.
So, it is -- that is true, and
you can also sometimes say, you
know, I am really sorry if I
have the time, I would.
But, I'm pressed for time, and
at least you acknowledged that
they wished, you wish that you
could, and they wish you could
and, and -- a competence factor,
you are acknowledging it, but
they understand that time is a
problem, too.
So, if you have to, if you have
to focus on something that, I
would say information in.
>> Ok.
>> Thank you very much.
>> No problem.
>> Elyse, our next question is,
is there any, anything at the
institute to be able to help
professionals and families have
talks about, about advanced care
directives?
>> You know, there is, if you,
you -- we have, we have a
resource called cace, which is
about making choices for where
to live.
If you type in, I'll just type
into my, my, my, into the chat
window here, type in CACE into
the Aphasia Institute website,
and you will find a resource
that shows, has pictographic
images and a video -- that has
pictographic images and a video,
that helps you make decisions
about discharge planning.
That's not exactly direct care
directives, but that's a start.
This, this reported conversation
can be used with any kind of
complex conversation about any
kind of future decision.
So, yeah, it can be used that
way.
And we do have, in talking to
your doctor, that resource, we
have a DNR illustration and, and
some other resources that, that,
that would be useful.
For those conversations.
>> Perfect.
And, and the next question was,
what is the best way to help
someone with Aphasia when they
seem very frustrated, trying to
communicate?
>> Well, the frustration is
real, and that is because, you
know, there is a couple of
things there.
One is, is that they do feel
like they are not being
understood, so all of the
acknowledging competence
techniques will help allay the
frustration, number one, because
they will know that, that you
know, that they do understand.
And they will start to know that
you are trying your best to, to
understand them.
And even if you are not
understanding them, if you
acknowledge in that process,
that, that does -- many, many
people I have seen, the
frustration level decreases
because they realize that, that
you know they are having a
problem, and you understand the
nature of the problem, and even
if you don't, aren't able to
exchange the accurate
information initially, so, that
acknowledging competence step
goes a long ways towards
decreasing the frustration level
because they feel they are
understood, at least at that
interpersonal level.
And after that, you can start to
try to exchange the real
information using the supported
conversation techniques, and
that when, will certainly start
to allay the frustration of them
not saying that they are being
understood.
That's if it's a communication
problem purely.
If it's also a cognitive,
cognitive problem, an impulse
console problem, and other,
other aspects on top of the
communication problem, that is,
that is an additional aspect
that you will have to assess as
you go along, and see whether,
is there frustration more of an
anger, an impulse control
problem?
You know, but, if it's a
communication problem, that you
can, you can use the supported
conversation techniques, and
even if it's an impulse console
problem, you can use the
techniques to help them
understand, you know, that you
indicate that you understood
they are frustrated, too.
>> All right.
And the next question was, could
you tell us where to get the
free information on the Aphasia
site?
>> Yes, go to the, go to the
Aphasia institute store, and you
see the working together series.
We're working on improving the
website, but if you go through
to the, to the checkout area,
there is a way to, to add your
code.
And if you have difficulties,
I'm going to -- you can,
actually, I will just write the,
the -- I will write, write in
the email address, for the
education coordinator.
You can, actually, email her.
>> Ok.
>> And is there an electronic
version or app of the pictograph
for tablets or phones?
>> That, we are, actually, as I
mentioned, in about a month, all
of our illustrations will be
uploaded to our website, and you
will be able to download them,
save them on your system,
whichever system you are using
in a pdf format, and they would
be able to use them in any, any
electronic device, in a pdf
format.
That's coming.
So, stay tuned.
If, if you are on our, our --
I've been here today, you are on
our, our system, and we'll email
you as soon as the, the new
website is up.
It will be there shortly.
>> Ok, awesome.
>>> And last question, any
suggestions of people keep
trying to want to speak again,
even though they cannot, and
they do not focus on using
strategies, for example, writing
or drawings?
>> Oh, yeah.
I suspect that, Betty, you are
talking about somebody who is
fairly recently injured or, or
having, having had a stroke, and
they are not really
understanding that, that they,
they, that this is a problem
that they have to try to adjust
to.
I would say, I don't tell them
that they won't speak again.
Actually, we don't know that.
You know, it's, it's surprising
how the brain can change, and
over time, two, three, four
years of time, things can
change.
So, I always say that, that the
writing and the drawing is for
now.
And it's to help me understand
you, right now.
Also, sometimes, the writing and
the drawing can be therapeutic
because it stimulates the
brain's pathways, so, I talk
about it as a therapy technique,
and as a communication
technique, that's important
right now, so I can understand
you.
And, and it's not instead of
talking.
Because, because people don't
want to hear that, and we don't
really know that, that there
won't be talking in the future.
So that way, you know, you don't
disappoint people, and you can
get them to focus on, on the,
the most important technique for
communication in the present.
>> All right, and we have two
more questions come in.
The first is, there work being
done to create gifts to
represent meaning?
>> I think that I need a little
more information about that
question, Jodi.
Do you want to unmute and maybe
ask me on the phone?
Oh, now, what you will find is
on the self directed learning
module, we have over 15 small
videos that illustrate these
various techniques.
So, we have done that, and when
you go to that self directed
learning module, you will see
the videos, and you can watch
them as often as you like,
replay them and watch them.
And, and so, I think that that's
what you are meaning, certainly,
we find that, that, that, yeah,
oh, you mean, oh, videos for,
for patient usage?
You know, we have not done that.
What we find is that, is that
because we're, we're, our
techniques are meant to be used
with, with, with conversation,
with real life conversation, we
find that the static images are
there to be part of a real
conversation.
So, we have never, actually,
made videos.
I think that there might be an
issue around focus and working
memory and, and other reasons
why, why, you know, the real
life human conversation, and
then with the, with the added
support of the static images,
seems to work best.
I have not thought about using
videos as a communication
strategy, but that's an idea.
I will think about that.
Talk to my colleagues.
>> Another question, would a
speech therapist be available at
a hospital to facilitate or
teach a family how to speak to
someone with Aphasia?
>> Certainly, if you have a
speech therapist who is in the
hospital where you are, your
family member is, they should be
aware of the supported
conversation, that's pretty --
it is an evidence-based
strategy, been out for a number
of years, so, I would think that
they would know how to use the
technique, and I would approach
them and, and see if you can get
a referral, if they can be there
to help you, as I mentioned, the
coaching from a real therapist,
in the moment, is really the
best.
So, I would ask, definitely.
>> Yeah.
>> They should be -- most people
have, most therapists have,
have, have, somewhere knowledge
of it or they could watch the
self directed learning modules
themselves, and be up to speed a
bit.
>> Perfect.
And any last questions?
>> I left the email there.
She can direct you to the free
resources.
It's not obvious how to get to
them, but she can help you with
that.
>> Thank you.
Is there any other questions?
Again, star 7 to unmute.
>> if people can ask me or type
it in.
>> Hello.
>> Hi.
>> Hi, there.
My name is Jenny, and I am an
O.T. working with seniors in the
behavioral support team, and I
am just about to work with, with
a couple, one of them has
profound hearing loss, that does
not have any cognitive issues.
And the other, his spouse has,
has cognitive issues.
And has issues with, with
literacy.
So, I'm, I'm -- I'm wondering
from your perspective, kind of
where should the focus be or who
should the focus be on if they
have issues.
>> Do they have issues you are
trying to address as far as
their activities of daily
living?
>> Right.
>> Yeah.
With the, with the person who
has the hearing loss, you can
use the written key words to, to
facilitate him or her
understanding you.
So that would be -- I would sort
of make sure that I write the
key messages down so that he can
focus on those, so, because he
won't be able to hear you very
well, and with literacy, sounds
like they are understanding what
you are saying, and you might
use illustrations or another way
to make sure that they are
comprehending you.
>> Ok.
>> And we do have a -- talking
to your occupational therapist
resource, and in the Aphasia,
that you might find helpful to
have illustrations for ADL and
other, other things.
So, and also, talking to your
physio people.
>> And what about their
interaction and communicating
between the two of them?
That seems to be the breakdown
and the focus of my team.
>> So, I would -- you know, you
could, actually, teach the
person with hearing loss to do a
bit of gesture or drawing to the
spouse that has the, the
literacy issues.
To make sure that they
understands what, that he or she
understands each other.
So, I could -- it sounds like
gesture or pointing or, or, you
know, thumb's up or down, and
those kinds of easy, easy,
easily understood gestures might
be helpful for both of them.
>> Ok. Thank you.
>> Yeah, you are welcome.
>> So we have time for one more
question.
Star 7 to unmute yourself.
Well, thank you very much,
Elyse.
That was very informative.
And thank you, also, to all our
participants for attending
today.
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Have a great day.
>> Thanks, everybody.