Facilitating Functional Communication

  1. Environmental Modifications #

You may consider optimizing your client’s spaces for face-to-face conversations. This might include limiting background noise/distractions, facing your listener straight on, and having communication partners wear any hearing aids or glasses for the conversation. Common methods include:

  • Modifying the seating arrangement to face your communication partner head-on.
  • Turning off fans and AC to limit background noise.
  • Turning off TV, Radio, and other sources of noise.
  • Turning on lights or opening the curtains to better see your communication partner.
  • Wearing glasses to better see your communication partner.
  • Wearing hearing aids to better hear your communication partner.

  1. Self-Advocacy  #

You may consider ways for your client to self-advocate for themselves in everyday conversation, to let communication partners know about their condition or speech disability. This may include having a wallet-sized card that offers insight to third parties who may make assumptions based on a client’s speech, or shortcuts on a speech device. Common methods include:

  • A wallet sized card that says “I have difficulty speaking due to a medical condition. I can hear and understand you. If you do not understand me, please let me know”.
  • A wallet sized card that explains “I use a speech generating device. Please give me time to respond.”
  • A communication card with common phrases for daily life, including:
    • Buying bus & train tickets at the counter: “1 ticket to Union Station, Toronto, please”, “1 ticket to [my home station], please”
    • Grocery store options: “Please put this in the bag on my wheelchair”, “1 Lotto Max ticket, please. No extras”

When first diagnosed, clients can have high communication participation and demands . This can be highly distressing while patients continue to work for their employer or speak regularly with the public. Consider the patients’ roles when discussing self-advocacy and counsel the client on how they best can self-advocate if listeners are surprised or having new trouble understanding their speech.


  1. Partner Strategies  #

Family and friends of clients with ALS can optimize how they communicate with their loved ones by taking some ownership in the communication interaction to help ensure its success (e.g., verifying that they understood the message correctly, asking one question at a time, being honest in regarding what parts of the message they understood and asking follow-up questions). When clients and their partners create a system for determining the client’s communication intentions, partner strategies can also be considered a form of augmentative and alternative communication.

If the client’s communication becomes more difficult to understand, AAC (Augmentative and Alternative Communication) should be considered.

Particularly in the later stages of dysarthria progression, family and friends play a key role in a patient’s continued communication participation. Sharing information on supported conversation strategies and partner supported scanning with family is a great way to help ensure patients continue to participate well in meaningful conversations with their loved ones.

Sources & Further Reading #

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