icommunicate Guide Adult Information Learning Difficulties Total Communication
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What is total communication? This is a holistic view of communication, often using a range of modalities or even thinking “outside the box” to create a system of communication that works for an individual. Other definitions of Total Communication include:
Here are some examples of modalities that may be used in a Total Communication approach. This is not a complete list but covers many aspects of communication. Every individual is different and some may use a several ways to communicate: 1. Touch cues Touch cues are a way of giving blind/deaf individuals, or individuals with learning difficulties information about what is going to happen. Touch cues help individuals understand activities, people and places through the use of touch. For instance, a hand on the shoulder may mean “sit down”, or alternatively the individual may be guided to touch a familiar persons watch or ring to let them know who is present. When all communicators use these cues consistently in daily routines this helps the individual understand and make sense of his surroundings and recognise the people he meets. 2. Texture cues / Objects of reference Through the use of objects or tactile symbols, individuals can build up a wide range of communication options. These systems are generally used with clients with visual difficulties and /or severe learning difficulties who are non-verbal. Some clients may lack the motor skills to learn signing so touching objects may be a better alternative. In their simplest form objects can be used to give individuals an idea of what is about to happen e.g. give them a spoon and they know its time for lunch, or a towel before going swimming. However, this form of communication can also be used in many more complex ways and the individual can communicate, make choices, learn language and organise. Symbols or objects can be placed within easy access of the individual, and using a series of textures and shapes many words or concepts can be represented. For instance, a certain texture may denote “location words” and then on top of the texture you may have a spoon which would identify the cafeteria. 3. Braille This system was devised by Louis Braille in 1821 and is a method widely used by blind people to read and write. Letters and numbers are represented in a cell containing 2 columns of 3 dots each. A dot may be raised at any of the 6 positions to form 64 combinations. Each cell represents a letter or number. The blind individual runs their fingers over the raised dots and translates the dots in to letters and then words. Although this system may seem complicated, it is no different from sighted people learning to read regular letters. Efficient braille readers can use this system to read quickly. Labelling machines have been developed so that everyday items can contain a braille label and facilitate the visually impaired individual to perform everyday tasks. Tasks such putting the washing machine at the right setting, or distinguishing between the jar of jam and pickle can be made simple with the use of braille labelling.4. Environmental cues This is a general description for many cues that are around us. They can include pictures, logos, colours, noise and texture. They may not immediately stand out as modalities of communication but they guide all of us day to day e.g. the doorbell, the colour red for danger, a picture of a deer on a road sign. 5. Facial expression, gesture and body language These are the more obvious examples of non-verbal communication but are important because they carry so much meaning and can be used very successfully by people with communication difficulties. Facial expression not only sends a message on its own, but it can greatly enhance or change a verbal message. It is important for sending and receiving a message. Body language and gesture has similar significance. Often this can be very subtle and the communicator may be unaware of the movements they are making. However, good gesture skills amongst individuals with communication difficulties can enhance their message and help them be understood. Like facial expression, gesture can express a variety of feelings and thoughts. Conversely, gesture may help the individual understand a message when they have difficulty following spoken language. We just have to think about how much gesture we use when we communicate in another country and do not know the language, to realise how much gesture can help communication. 6. Signing Systems There are a number of different signing systems which vary greatly in complexity. Probably the most well known is sign language for the deaf. This is whole language encompassing a wide vocabulary and grammatical structure and also involving facial expression. Individual countries have their own signs and often areas in a single country will have some regional differences (like having a local dialect or accent). 7. Pictures / Visual Strategies Visuals and pictures can work for many individuals with communication difficulties. Visual strategies can be used in a multitude of ways to enhance understanding and expression. They are particularly useful for non-verbal individuals, individuals with learning difficulties, and/or those with autism. Some individuals are “visual learners” and respond better to visual input than auditory input. Visuals can be used in isolation to represent single words or actions and make choices, and they can be used as social stories. Some individuals find it easier to follow visual schedules to help with routine, and visuals can be used as an additional cue to the spoken word. 8. Print and Symbol Systems A printed word or recognisable symbol system can be used when other forms of communication fail. Some people may even draw a picture to get their message across. Using alphabet charts is another way to use print to communicate. By pointing to the first letter of the word on an alphabet chart the individual with a speech difficulty will often cue in the listener into the word. 9. Assistive Technology / Communication / AAC Assistive technology can be a huge facilitator to adults with learning difficulties, helping them to communicate and share information across environments. Assistive technology can be broken into 2 sub-categories – hi-tech and lo-tech: Hi-tech generally refers to electronic devices. These tend to be a more expensive option, but can be very sophisticated machines which provide voice output and environmental control. Hi-tech options can also have additional software which helps with typing, word prediction and scanning. Lo-tech refers to less technical options such as picture communication cards, communication books or an E-Tran frame. Although often overlooked, these options can actually be more effective than a high tech option. An important point to note here is that when looking at assistive communication devices, it is crucial that you do a thorough trial of several different options to really find the best fit. The higher tech, most expensive option is not always the best. You have to take account of many variables including portability, functionality and speed of use. See our section on Assistive Communication for more detailed information relating to hi- and lo-tech assistive communication devices. 10. Speech, Voice and Language Many people with communication impairment are still able to use their voice and speech. However, they may have other difficulties with communication that reduce their ability to get the message across (difficulties with social skills, understanding, intonation, eye contact, topic maintenance, proximity, turn-taking etc). When some aspects of communication are difficult it is important to focus on other areas to enhance the spoken message, and this may include using other forms of communication that have already been mentioned.Good communicators must be aware of their rate, volume and intonation as well as using gesture and facial expression to help the listener understand the message. As skilled communicators we must also be aware of the complexity of the language we are using. For instance, if an individual’s level of understanding is at the 1-word level there is no point asking them to go and fetch three different objects, they will either not understand, or only be able to pick out the name of one of the objects. Remember to pitch your language at a level that the listener will understand and give them plenty of time to process the information. For those individuals that have very delayed receptive language skills, using the Minimal Speech approach can have a positive effects for communication and behaviour. The Minimal Speech approach focusses on trying to reduce the number of sentences and the length of sentences when communicating. Use 1 or 2 key words rather than sentences.
11. Eye-gaze and Partner Assisted Scanning Some of the newest technology available to access a computers or communication machine is eye-gaze. The user's eye is calibrated with the screen and then his eye movement corresponds with the movement of the cursor. The user moves the cursor around the screen by the movement of his eye and when he holds the cursor still on an item, this is equivalent to a mouse click. So if the user has keyboard layout on the screen he just has to look at the letters on the keyboard to type them. This is really cutting edge technology and for some it could be a much faster way to access technology than using regular scanning.A lo-tech, but very effective form of eye scanning, is the E-TRAN frame, or adapted communication book. The frame or book may vary in design but can be made of a transparent material (like a window) with a communication partner sitting on the opposite side. On the window are a number of visuals, symbols and/or letters etc. The communicator looks in the direction of the symbols and the communication partner follows the message by following the communicators eye gaze and asking questions.
For more information, resources, and books related to communication and communication difficulties, visit our online Resource Centre.
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