How do you explain to a doctor, a shop assistant or a new teaching assistant how to communicate with someone who uses AAC? With a ‘How to talk to me’ card: a few sentences, on paper or in their tool, that say how they communicate and how to help. For health, it is completed by a hospital passport and a hospital kit.
Why does introducing yourself change the conversation?
Faced with an AAC tablet, many people don’t know what to do: they talk too fast, speak to the person accompanying them, finish their sentences or give up. The card gives them the instructions. AAC users aged 12 to 44 were judged more competent by their communication partners when they started with an introduction message (Light and Binger, 1998): same person, same tool, a different view of them.
What goes on the card?
- Who I am: first name, possibly age.
- What I understand: ‘I understand what you say’, or ‘Please talk to me in short sentences’.
- How I communicate: tablet, phone, board, gestures, signs.
- What you can do: wait, read my screen, offer choices, check.
- My yes and my no: the exact gesture (nodding, thumbs up, looking up…).
- Guessing or not: some people like you to guess, as long as you check; others prefer to finish their message.
- Who to talk to: me, not the person with me.
Who I amMy name, and what I understand
How I communicateMy tool, my yes and my no
How to help meWait, read my screen, guess or not
Who to talk toMe, not the person with me
Write the card in the first person, with them, and let them approve each line. Keep it short and specific to each situation: a waiter needs to know how to take the order, not the person’s whole life story (Collier and Diamanti, 2007).
Three templates to copy
Adapt each part in square brackets.
General version
Hello, my name is [first name]. I understand what you say to me. I talk with [my tablet / my phone / this board]. I need a little time to answer: please wait for me, and don’t finish my sentences for me. You can read my screen and ask me if you have understood correctly. To say yes, I [nod]; to say no, I [shake my head]. [You can guess, I’ll tell you if you’re right. / Please let me finish before you guess.] Please talk to me directly, not to the person with me. Thank you!
Short version, for shops
Hello, I’m [first name]. I talk with this tablet. Please give me a little time. Thank you!
Version for the doctor or hospital
Hello, I’m [first name]. I understand what you say, please talk to me directly. I communicate with [tool]. For yes, I [gesture]; for no, I [gesture]. For pain, show me the 0 to 10 scale and I’ll show you how much it hurts. Explain what you are going to do before you do it. My medicines and allergies are in [my hospital passport].
Keep a paper version in the bag. In Buddy, a single button can speak the whole introduction, the page can be printed, and the Springboard 48 and Horizon 80 vocabularies have an ‘Introducing myself’ page; so that the other person can read the message on screen, set the sentence bar size to ‘Extra large’. Printable materials are on the resources page.
How do you learn to use the card?
Choose a situation (ordering at the baker’s), explain what the card is for and demonstrate it by playing the person’s role. Practise with role play at home, then for real, with support that is gradually withdrawn. Review how it went, then try other situations (Beukelman and Light, 2020).
Which messages help to keep your turn and repair a misunderstanding?
Other short messages help to keep the conversation going (based on Beukelman and Light, 2020):
- Keeping your turn: ‘Hold on, I’m typing…’, ‘I haven’t finished’.
- Organising the conversation: ‘Please stand where I can see you’.
- Repairing a misunderstanding: ‘That’s not what I meant’, ‘I’ll start over’, ‘You’re almost there’.
- When the word is missing: ‘That word isn’t on my tablet’, ‘Give me some choices’, ‘It starts with…’.
Learn at least two ways to repair: repeating the message, or changing it (adding a word, simplifying, saying it another way). In Buddy, the ‘Being understood’ page groups these messages together. Other ready-made phrases are in Beyond requests.
The communication dictionary, for people who communicate through gestures or sounds
When the person mainly expresses themselves through gestures, sounds or facial expressions, add a communication dictionary: for each signal, a photo or a short video, what it means and how to respond, displayed at home, at school or at the day centre.
| Signal | What it may mean | How to respond |
|---|---|---|
| Licks their lips | My lips are dry | Offer lip balm |
| Grimaces | It hurts, or it’s itchy | Ask where, show the pain scale |
After a short video of this kind, classmates read the signals correctly 86% of the time, compared with 33% before (Holyfield et al., 2018).
In hospital, why is it a safety issue?
Without effective communication, a patient is about three times more likely to experience a preventable adverse event (Hurtig et al., 2018). Of the nurses surveyed, 95% had patients who would have benefited from AAC (Hurtig and Downey, 2006).
This also applies to patients who have lost their speech through a stroke, Guillain-Barré syndrome, intubation or a tracheostomy, and to those who don’t speak the team’s language. They need more than yes / no: knowing where they are and what is going to happen.
What should you prepare before an appointment or a hospital stay?
The hospital passport, a short document to hand in at reception (Blackstone and Pressman, 2016):
- How I communicate and how to help me (the ‘How to talk to me’ card).
- My signal for yes and for no.
- My medicines, my allergies, my medical history.
- What reassures me, what makes me anxious (noise, waiting, being touched).
- The people to call.
The list of symptoms and questions: what is bothering the person, sorted by part of the body, and what they want to ask (‘Will it hurt?’, ‘When can I go home?’). Before a test (blood test, X-ray, MRI scan), show them photos or a video of what happens. At the doctor’s, ask for a longer appointment or the first one of the day, send this list in advance, let the person answer for themselves and sum up with them what has been decided.
PrepareThe hospital passport, the symptoms and the questions
Show the testPhotos or a video of what happens
Let them answerThe person answers for themselves
Sum upWhat has been decided, with them
Recorded messages: before an intubation or planned surgery, the person can record messages in their own voice; in one project with children, 30 to 60 messages had been prepared (Costello, Santiago and Blackstone, 2015). Voice banking is explained in AAC for adults.
Which communication kit should you take to hospital?
The kit must be usable by any healthcare worker without training, and exist on paper: a tablet can’t go everywhere, and its battery runs out.
| Section | Suggested content |
|---|---|
| Yes / no | The person’s code, displayed in the room and noted in their records, plus ‘I don’t know’ |
| Needs | Thirsty, hungry, suction, toilet, turn me over, too hot, too cold, moisten my lips, medicine, sleep, call the nurse, call my family |
| Feelings | I’m scared, I’m worried, lonely, lost, tired, uncomfortable, I’m OK |
| Pain | A 0 to 10 scale with faces, and a body chart |
| Room | Light, TV, bed, on / off, up / down |
| Alphabet | A board with ‘mistake’ and ‘I’ll start over’ |
| Orientation | Where am I? What happened? What day is it? What’s going to happen? |
| The unexpected | ‘It’s not here’, ‘something else’, a few blank cells |
Words for the body and pain, and consent to care, are covered in Body, pain, consent. With Buddy, boards print with the same layout as on screen, and the app works offline (useful when the signal is poor). For a patient who can only move their eyes, an eye-pointing board or an alphabet read out by the healthcare worker are still the quickest solutions (see Access: positioning, switches, eye gaze).
Healthcare staff: how can you make communication easier?
- Speak to the person, not to the person accompanying them.
- Use the same yes / no code as the whole team, displayed by the bed.
- Ask closed questions ending in ‘yes or no?’, and use writing or symbols.
- Give them time, without finishing the patient’s sentence (see Model, wait, respond).
- Look out for natural signals and ask for the communication dictionary.
- Record everything in the notes: a child in rehabilitation can meet more than 26 professionals in two days (Gormley and Light, 2018).
After short, just-in-time videos, rehabilitation staff offered choices in more than 70% of interactions, compared with 7% without training (Gormley, 2019).
In an emergency in the UK, people who have difficulty speaking or hearing can contact 999 in text through Relay UK (18000), or by SMS once registered with the emergencySMS service.
Frequently asked questions
Can you take your AAC tablet to hospital?
Yes, it is recommended. Bring a charger, a protective case and a paper backup for times when the tablet can’t be used.
Does the card replace the communication tool?
No. It opens the conversation; the conversation continues with the person’s tablet, board or gestures.
Pictalk Buddy brings together AAC boards, a visual schedule, guided sequences and notebooks, with the same symbols, on Android, iOS, the web and the watch. A pay-what-you-want app, developed by a non-profit association. Discover Buddy
Sources
- Beukelman, D. R., & Light, J. C., 2020, Augmentative & Alternative Communication (5th ed.), Paul H. Brookes, chapters 3, 4, 11, 13 and 18.
- Studies cited from Beukelman & Light (2020): Light & Binger (1998); Collier & Diamanti (2007); Holyfield et al. (2018); Hurtig et al. (2018); Hurtig & Downey (2006); Blackstone & Pressman (2016); Costello, Santiago & Blackstone (2015); Gormley & Light (2018); Gormley (2019).
- Relay UK: contact 999 using Relay UK.