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Multiple disabilities, communication and communication aids – Communicating differently

Chapter 17 of the book “La personne polyhandicapée – 2e édition : La connaître, l’accompagner, la soigner”. P. Camberlin and G. Ponsot. Coll. Guide Santé Sociale. January 2021. Dunond: Malakoff

Chapter written by Cataix-Negre E.

Mediation/Education :

Communicating enables us to exist and build ourselves, to express our needs, emotions, thoughts and desires, to exchange information, to receive and transmit messages, to relate to others and to socialize.

The person with multiple disabilities has a communication handicap due to his or her altered, difficult-to-interpret and subjective expression, but the partner also has a communication handicap, in that he or she has great difficulty in understanding and making sense of the person’s bodily and non-verbal manifestations, and in making him or herself understood.

In the communication process, only 7% relies on oral language, 38% on tone and sound of voice, and 55% on gestures and facial expressions.

General principles of alternative and augmentative communication (AAC)

  • Substitution and multi-modality

The aim of “alternative” communication is to propose alternative means of communication when natural communication is not sufficient to be functional.

A wide range of AAC activities and resources are available:

  • facial expressions and mimics, body gestures, signs
  • significant symbols representing a concept in object, image, pictogram or other form, on a panel or board assembled in non-technological technical aids
  • electronic devices with voice synthesis.

For people with multiple disabilities, multi-modality is essential.

  • Language bath and modeling, observation and evaluation

Creating a language bath in CAA means experiencing a real communication sequence, in real life, with real objectives. We need to adopt a positive “modeling” attitude, i.e. to use the person’s AAC tools as a complement to speech, and to use simple language.

With an attentive, “modeling” human environment, more relevant assessments can be carried out, and a multi-disciplinary observation grid constructed to build an individual communication project and set up AAC resources adapted to each person.

What AAC methods should be used with people with multiple disabilities?

  • The communication passport

Notebooks, posters, leaflets, booklets that explain in words, photos and images how the person communicates best, they make it easier to enter into a relationship and link up with new communication partners.

  • Daily tools: timetables, displays, activity boards, signage

Ideally, the entire visual and human environment should provide multi-modal information.

The communication board for clipping on two or three images offering a choice to people (meals, dressing up).

A timetable representing the passage of time, with easy-to-understand supports that can be put down, taken off, moved and matched, to work on the meaning of images.

The activity board, for a specific activity “staging” the activity with images.

  • The life notebook

Often the first tool, sometimes the only one, with a biographical structure, it’s a diary in pictograms, drawings and objects that builds up over time, months and years. It elicits mental images of real-life situations.

  • Communication boards with contextual classification

Plates of pictograms, images and photos that are supposed to be put together to express a message. Everything has to be adapted to the individual, from the table to the type of pictograms. Designation can be manual, ocular or via the partner.

  • Communication devices

They are numerous and their usefulness is undeniable. The impact of the voice allows you to hear yourself, to check your message, to be heard. Talking buttons, message boxes, digital tablets – the possibilities are immense, but we mustn’t make them too rich.

Necessary and indispensable time

Ideally, technology and non-technology should complement each other to create an AAC tool. And time, a time shared at the pace of the person with multiple disabilities. The partner is the “go-between”, an essential link whose intelligence, availability and sensitivity establish communication.

For more details, we invite you to read the chapter written by Cataix-Negre E. (2021).