Communication Tools: Communicative Access & SCA™
Supported Conversation for Adults With Aphasia (SCA™) is a program that uses a set of techniques to encourage conversation when working with someone with aphasia through:
- Spoken and written keywords
- Body language and gestures
- Hand drawings
- Detailed pictographs
SCA™ is designed to help people who “know more than they can say” express their opinions and feelings in a way that makes them feel valued and heard. Through the program’s techniques, conversation partners such as family members, doctors, nurses, or friends, can help break down the communication barrier and help people with aphasia re-join life’s conversations.
The goals of Supported Conversation for Adults With Aphasia are:
- Acknowledge the competence of the adult with aphasia.
- Help the adult with aphasia to reveal his or her competence.
People with aphasia need others to believe they are competent and have more understanding and social skills than may be apparent.
Acknowledging competence can be through a tone of voice that is natural, choosing adult or complex topics for discussion, or integrating techniques into natural talk. Helpful strategies include:
- Saying “I know that you know” at appropriate times.
- Attribute communication breakdowns to your limitations as a communicator, “You know I’m not good at explaining these things clearly!”
- Deal openly when you have to communicate with a partner to obtain or give information.
Despite best efforts, there will be times when communication breaks down – it is valid and comforting to acknowledge the shared experience of being frustrated.
There are communication techniques that can help ease the exchange of information and feelings between the conversation partner and the person with aphasia. The key is ensuring messages are taken IN, OUT and VERIFIED by the person with aphasia.
Getting the message IN is a matter of modifying the way you converse to ensure you are being understood by the person with aphasia. Some methods to try include:
- Using short, simple sentences and an expressive voice.
- Using gestures when conversing.
- Writing keywords or main ideas down – e.g., PAIN in large or bold print.
- Using pictures and focusing on one at a time.
- Eliminating distraction – noises, other people, or multiple visual materials.
- Observing the person’s facial expression, eye gaze, body posture or gestures to determine level of comprehension.
Getting the message OUT might be a bigger challenge for someone with aphasia. To help them express their thoughts to you, try:
- Asking yes or no questions.
- Asking one question at a time.
- Asking him/her to gesture, point to objects or pictures, or write key words, such as “Can you show me…”
- Giving him/her sufficient time to respond.
- Asking fixed choice questions such as, “Do you want water or coffee?”
- Phrasing yes or no questions from general to specific.
Verifying the message is important to making the person with aphasia feel understood and valued. Summarize slowly and clearly by saying, “So let me make sure I understand” and using the following methods:
- Adding gestures or written key words.
- Repeating the person’s message.
- Expanding on what you think the person might be trying to say.
- Recapping the conversation if it was a long one.
How to Use Communication Techniques
The fundamental thing to remember when working with someone with aphasia is to be natural. Use communication techniques when breakdowns occur, gradually layering when needed. Overusing communication techniques can also cause incomprehension if the person with aphasia feels you’re being patronizing. Watch the cues from the person with aphasia closely and follow the path that seems to be getting the most response. And remember – everyone experiences communication challenges from time to time, even the most skilled communication partners.
Those with severe aphasia will likely need more extensive support to absorb messages both in and out so use as many communication techniques that appear to be helping.
When communicating with a person with aphasia, keep some of the following materials on hand to help enable conversation and comprehension:
- Blank paper to present one or two pictured items or words at a time.
- Markers or pencils – the bolder or larger the writing, the better to see so use a thick black marker. For those with aphasia, writing with a pencil is easier. Make sure to place the pencil and paper right in front of him/her.
- Cut out window, created from construction paper – use this to frame one picture at a time.
- Paper and flashcards – whether letter-sized or small sheets, flashcard can be used to write keywords (e.g., TOOTHBRUSH) or to introduce or change a topic.
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