The blogs on stroke and brain injury found on VoiceforLiving.com have highlighted the benefit of multi-modal communication, the role of the communication partner and the importance of honoring the personality and interests of the individual.  Today, I want to tell you a story that shows the result of all of these important topics.  

Kristy was a woman who suffered a severe brain injury.  As a result, she was blind.  Her muscles were so tight that she was in pain most of the time and could hardly move.  It was not clear initially what she was able to understand because she had no consistent physical movement.  We tried to establish a “yes” response by having her turn her head to the left for “yes.”  Even this was difficult and, often, a look of effort around her eyes was accepted as “yes.” 

This occasional head movement lead us to provide her with a switch by her head to call for the nurse when in bed and without family present.  This switch also connected to a communication device that she could use to gain attention with a single message when her family was present.  

Though her response was not physically consistent, Kristy’s responses to yes/no questions regarding her life and world knowledge were accurate when she was able to respond.  Therefore, we taught her family and the nursing staff how to provide choices verbally using partner assisted scanning (see photo) [gfx: partner assisted scanning] and, subsequently, we found that Kristy was able to spell using this technique (see description in Kristin Whitfield’s blog called “Encouraging Multiple Means of Communication”).   The process was slow because of her difficulty responding and she was rarely able to complete a word because of her pain and fatigue but she could often provide the first letter or two allowing her communication partner to predict what she might be expressing. 

Kristy’s mother entered her daughter’s room one day to hear music playing and to see her daughter’s hand raised in the air moving back and forth.  Knowing that this movement was unusual, Kristy’s mother suspected that this was a result of tightness in Kristy’s muscles and that she must be in pain.  Her mother provided Kristy with the opportunity to express pain or a need using the communication board above without any response.  She turned the board over to the alphabet side thinking that maybe what Kristy wanted to say was not on the board.  She began to go through the letters on the alphabet board.  With effort, Kristy spelled, D…A…N.    Her mother realized that her daughter was spelling the word, “dancing.”  Kristy was dancing!  It was something she had always loved to do and she and her mother were able to share a moment of remembering times she had danced in the past and form a memory of dancing in a new way.

 As we learn more about AAC tools and techniques, let us remember that the desired result of them is not perfect interactions but connection with another person.