One of the patients I remember very clearly from my time as and SLP at a large rehabilitation hospital is a man I’ll call Arthur. Arthur was in his 50s and had had a brainstem stroke a number of years before I met him. As a result of the stroke, Arthur was unable to speak or really move anything but his head.

I worked with Arthur, his social worker and his sister to help identify the type of communication device that would help him communicate with his family and the nurses who cared for him in the nursing home. After a few trials, we settled on the DynaVox 3100 that Arthur operated by turning his head slightly to touch a switch. He could use the device to speak complete messages (things he said frequently or messages that he used to get the nurses to stop and listen), spell out new messages, and operate his television. Arthur clearly loved communicating with his device and he was good at it.

Even though Arthur was a good communicator with his DynaVox 3100 it didn’t replace his other means of communication. In the years between his brainstem stroke and the time I met Arthur, he used an alphabet board to communicate. Since he couldn’t point to the letters, his communication partner would point to a row and ask, “Is it in this row?” If Arthur looked up to indicate “yes” his communication partner would name all the letters in that row until Arthur looked up for “yes” again. Then, his communication partner would move back to the top of the board and ask about the next letter saying “Is it in this row? This row? This row?” until Arthur said “yes.” Then she would say each letter in the row until Arthur said “yes” for a certain letter. At that point, his communication partner could sometimes guess the word he was spelling and start the process over with the 2nd word. If the communication partner couldn’t yet guess the word, she would continue the process to identify the 3rd, 4th, or more letters in the word.

This approach is called partner-assisted scanning. It is a great way to use a communication board; alphabet board; or even a collection of symbols, photographs, or objects for someone who has very limited movement or very limited control over their movement. It seems like a really slow way to communicate, but for Arthur and his sister it was amazingly fast. Because they had used the method for so long, Arthur and his sister did not need to even use the alphabet board. She could say “Is it in the first row? Second? Third?” and when he said “yes” she could name the letters in that row without looking at the board. She also knew Arthur well and it was very infrequent that he had to spell out a whole word—she generally guessed the word with just a few letters. This was really neat to see and it makes sense that they would continue to communicate in this manner sometimes.

Arthur, his DynaVox 3100, his sister, and his alphabet board taught me a few things:

1. Just because someone has a communication device (even the most full-featured and complex device), we shouldn’t expect that it is all they will use to communicate. We still need to honor, and encourage, multiple means of communication.
2. Communication is about more than exchanging information. It can be about developing a relationship with someone. Sometimes it was easier for Arthur to use his alphabet board because his sister could sit down next to him on the bed and he could be close to her. This closeness might make it easier to share a fear, a personal issue, or simply enjoying being together. We need to remember that multiple forms of communication will help people communicate multiple different things for multiple different reasons.