AAC

Even
experienced
communication
aid users can
struggle to
express
complex views.
Joan Murphy
describes the
impact a low
tech tool
developed to
address this has
had on the
lives of people
with severe
communication
difficulties.
Tall<ing
Mats :
Speech and
angua e
researc
in practice
I
n 1996 the Alternative and Augmentative
Communication (MC) research team at
the University of Stir"ling received a grant
from the Gannochy Trust to examine peer
interaction of adult MC users in a resi-
dential setting. Following the first part of the
research, involvi ng detailed observations of the
ni ne users who volunteered to participate, we
wished t o obtai n the clients' views and percep-
tions about our findings. Although many were
experienced communication aid users, we
were aware they might still have difficulty
expressing their views about some of the com-
plex issues we wished to ask them about,
either because they did not have the explicit
vocabulary in their devices or penhaps because
they had not had to think about these matters
previously.
The 22 iss ues we wished to discuss (Resource
I) included
residents ignoring each other
communication at mealtimes
reluctance to use communication aids
talking to staff rather than other residents
the use of pre-stored phrases in MC
pnvacy.
Having just acquired Boardmaker"HA software
(Resource 2), we decided to try to produce a
range of picture symbols representing these
issues. It was important they could be present-
ed in a clear. interactive and accessible way as
we wanted the MC users to be able to con-
sider the points in question and express their
views in their own time in an unambiguous way.
The framework we came up with proved so
successful that many people have encouraged
me to develop it for a range or clients. This has
resulted in the production of a booklet and
video package, Tolking Mots (Resource 3).
True representation
The basIC jus consists of three sets of picture
symbols pres _ ed to the person with the
communication drfficulty by attachrng the pic-
tures to textured mats. The client can then
select them, move them around and change
them until s/he is happy the picture
on the final mat truly represents mat meant.
The three picture sets are
I. Issues
2. Emotions
3. Inruences
The issue/s to be discussed can be anything
from a simple choice about daily living to a
complex matter relating to li fe e e ts. The
range of emotions allows the client to describe
his / her feel ings about each issue; the number
and subtlety wi ll depend on ability and age. The
Inruences include a range of factors which
might have either a positive or negative effect
on the issue being discussed.
Flexible framework
The framework is very flexible as it is up to
the people using the Talking Mots to decide
which issue/s, emotions and influences to
include. Once identified, they can be created
using whichever pictorial representation is
most suitable. Boardmaker picture commu-
nication symbols are attractive, flexible and eas-
ily modified but any picture symbols familiar to
the cl ient could be used provided they are
clear and illustrate the issues being discussed.
The mats I used are textured doormats which
can be bought in any hardware shop. They
were chosen because pictures with Velcro
TU
tabs on the back can be attached to them and
moved around. This means people can I era.
build up a picture of their views which t G
SPEECH & lANGUAGE THERAPY IN PRACTICE 199 11
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AAe
Case - Frances
Frances has cerebral palsyand uses awholerange ofcommunication methods,including hercommunication aid,voice,eyes
and facial expression. Asherspeech and languagetherapistIwantedtoknowwhatshe felt aboutusingthetelephone
and howbestIcould help her. Because Iknew herresidential situat ion Iwas abletomake up a range ofpictureswhich
mightbe relevantt o her.The Tolking Mots helped herexplain what shethinks aboutusingthetelephone - whatshe
finds helpful and whatdifficulties she has.Although Frances is an experiencedAACuser.ittakes hera lotoftimeand
efforttoexpress complexthoughts.
Thefirstmatallowed Francesto
indicate broadlywhatshe felt about
usingthe issue beingdiscussed - the
telephone - by eye pointingtothe most
appropnate emotion picture. Frances
indicatedthatshewas fairlycontent
usingthetelephone butthat she still had
a few problems.
.IV ai, - f!J I
These aretherange ofinfluenceswhich
were presented onthe second mat.
_ 'gj" [I, [ij]
ilEa II II
This IS the final matwhich Frances
gradually bui ltupbyeye pointingtothe
influences sheconsidered important
and whethertheywere positive or
negative. The things which Frances
found positive and helpfulwhen using
thetelephonewere
having enoughtime
having privacy
using pre-stored phrases
havi ng alteredthevoicetoachieve
maximum clarityonthephone
usingthe answering machine.
The difficulties forherwere
how to endthe conversation
problems when hercommunication
aid breaks down.
She also added itis difficultwhenthe
person she iscalling doesnotrealise
she is usinga communication aid and
doesnotgive herenough ti me t o
explainthi s. She feltgreatsatisfaction in seeing herviewsgraduallytakingshapeand beingclearly ill ustrated onthefinal
mat.
Theseviewswere usedtoplan furtherworkwith Frances. She is nowa memberofa smallgroup ofLightwnter users
whoareworkingon communication strategies includingtelephone use. She also attends Collegewhereone ofher
courses looksattelephone skills
12 SPEECH & LANGUAGE THERAPY IN PRACTI CE AUTUMN 1998
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AAC
then consider;change and confirm in theirown
time.For people with aphysical disability this
design removes the effort needed to finger
point,operate aswitch oraccess akeyboard -
the participant can simply eye point and the
communication partner can do the selecting
and moving ofthe picture symbols.
Talking Mats do not replace someone's com-
munication aid / MCdevice. Al lthe people
who have used the mats have done so in con-
Junction wrthboth their existingMCdevices
(wheretheyhavethem) and non verbal meth-
ods ofcommuni cation such as facial expression
and gesture.
Wide use
Onginal ly for adults With cerebral palsy using
high tech communicat ion aids, the mats have
since been employed by avariety ofpeople,
both children and adults with awide range of
communicat ion difficulties, inone to one situa-
tionsand ingroups. The case examples (I - 3)
illustrate howtheyhave been usedwith t hree
different people who are shown in the video
accompanyingthe booklet.
Talking Mats have also been used with anum-
ber ofother people in slight ly different ways,
forexample wrth people with learning difficul -
ties bypresentingfewerpicture symbols atone
time,The act ofphysically moving the picture
symbols on the mats seems to help people
organise their thoughts In a logical way and
all owsthem totake ti me toconsiderand alter
them if theywish. One man wrth severe learn-
ing difficulties used the mats to talk about his
weekly routine.He described clearly, bycare-
fully choosing and positioning the pictures on
the mats, how he likes gardening best but
does not enJoy the radio which is continually
played int he day centre he attends.
Atpresent Iam using Talking lv10ts with aman
who has 'locked in syndrome'. He uses alow
tech communication book With eye pointing
but finds t he same picture symbols with the
mats al low hi mto produce amore concrete
representation ofwhat he isfeeling. His wife
and Ihave pinned a mat to his wall so that,
when he explainshis feelings, his choice ofPiC-
tures can be left on the wall mat and staffon
different shifts can see at aglance what he is
feeling. Because it is visual and attractive the
stafftake morenotice and know it is his view,
notjust someone else's interpretation.
A numberofpeople have expressed an inter-
est in using the Talking Mots wrth otherclient
groups including children wrth language disor-
ders, children and adults with learning disabili-
ties, patients on acute wards, patients in along
stay hosprtal and people with degenerative ill-
nesses.
The Talking Mots framework is being incorpo-
rated into aprojecttriggered by the ChiTdren
in Scotland Act. This requiresthat children be
consulted in decisions affecting them, and the
project'saim IS todevelop trainingmaterialsto
enable staffwho workwith children toinvolve
"""""""""""""" ".."continued overleaf
Case 2 - Betty
Bettyhad had a strokewhich resuh:ed in severe expressive dysphasiaAsshewas
abouttobedischarged ITom hosprtal shewasanxious aboutcommunicating
onceshe wenthome.TheTolking Mats wereusedtohelp Bettyexplainwhatshe
feh: abouthercommunicationwfth hosprtal staff,familyandfriends.Shealso
describedwhatfactors helpedand hindered hercommunication.
Thisfinal matshowsthat Bettyfelt hercommunication wrth hosprtal staffwas
OKbutthatshe had mored i f f i u ~ wrthfamilyand friends. Thefactors
which shefelt helped herwere using
drawing
facial expression
humour
wrrting
gesture.
Thethingswhich made communication moredifficultforherwere
people notgiving herenoughtime
toomuch noise'
toO'manypeopleatonce.
Shefehra bitunsure aboutusing herlow tech communication book athome.
Usingtne'Tolking Mots clearly helped Bettythinkabouthercommunication
and express herviews. Theseviews were used in various ways - tomake
suggestionstothosewhocommunicated with Betty.tohelp hercommunicate
morefunctionally and tohelp herspeech and languagetherapistplan her
therapy.Thematshelpedtherapyand ward stafftobeawarethatshe had
definiteviews despite hersevere dysphasia.As a resulttheytookmorecare
withthenoise levels in theward and tookaccountofherdifferentreactions
todifferentpeople.
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Me
Case3 - Jamie
Jamie is a teenager who has cerebra palsy and normally uses a
low t ech symbol book Jamie has no useful speech and is unable
to use his hands for pointing. He eye points t o the left for 'yes'
and to the ri ght for 'no'. Jamie's teacher and school helpers gave
me a list of all his school activities which I transferred into
Boardmaker pictures.
Jamie's m at waspinned to the wall directly in 1Tont of him so he
could eye point to the four emotion pictures totell me which of
his school actJvrties he liked best whi ch were OK which were
boring and which ones he really hated.The activity pictures were
shown toJamie one at a time allowing him time to indicate what
he fett abouteach one. Jamie is normally easily distracted buthe
enjoyed using the mats, concentrated well and considered each
response carefully
Jamie confinmed this final mat really did express hi s feelings
about school and he w as delighted to show rt to hi s teacher:
h: was very helpful to let hi s teacher and his Mum see the
whole video ofJamie using the mats and Jamie himself has also
looked at rt - over and over again!
There w ere several offshoots. After w atching the video Jamie,
his teacher and his Mum were all more aw are of hi s desire and
abilrty to communicate and the need to stretch him.
Subsequently hi s low tech communication book has had sev-
eral new pages added and he is using rt wrth a wider range of
people. His speech and language therapist and teacher are also
looking at a more advanced high tech system as they feel the
A/phoTo/ker does not contain enough vocabulary for him.The
computer w ork in class has been changed tobe more moti-
vating and, although he still gets physiotherapy. he no longer
gets massage
l
..continued from previouspage ....... .......... .... ........ .....
them inmaking decisions abouttheirownlives
and theservices they use.Thisproject is fund-
ed by'Children in Scotland'and further infor-
mation can be obtained from Jane Griffrths, tel.
0131 667 4496.
Talking Mats therefore appear to have the
potentialtohelp many peoplewith communica-
tiondifficulties in manysituations.Iam exploring
the idea ofusingthem to develop a tool for
assessing people'sviews in relationtotheirqual-
rty oflife. Iwould welcome comments from
anyone about ways theyhave used the Talking
Mats orany ideasforfurtherdevelopment
For (urther in(ormation contact Joan Murphy,
Research Speech and Language Therapist,
Psycholog'; Department, University o( Stirling,
joan.murphy@stir.ac. uk
Note: In this article,MCstands foraugmenta-
ti ve and alternative communication and
describes any method ofcommunication which
supplements impaired speech or handwriti ng,
such as asymbolbook orelectronic aid.
Resources
I.Adescription ofall the issues discussed and
the results ofthe interJi ews have been written
up in the booklet Improving augmentedcommu-
nicationVlithinanorganisation, availablefromthe
MCResearch, Uni versity of Stirling, price [10.
2. The PictureCommunicationSymbols (PCS)are
1981- 1997MayerJohnson Co,PO Box 1579,
Solana Beach, CA 92075, USA,and are used
withpermrssion.
3.TheTalking ots packageisavailabl efrom the
MCResearch, UnIVersityofStifling.price[23.
4.The Lightw teris availablefromToby Churchill
Ltd, 20 ParrtonStreet. Cambridge CB2 IHRtel.
01223 56711 7 It is priced at 380 (plusVAT if
applicable).
5. The AlphaTalker is available from Liberator
Ltd., Whitegates, Swinstead NG33 4PA. price
[1275(+ VAT if appli cable). 0
Questions
Whatdo1",11,; ... " t.A..,.... ..::.
AAC usersare given theopportunitytoconsider,
provide AA
express and changetheirviews and feelings about
thatthei complex issues.
In hruAi ,I", When carers see how clients reallyfeel aboutvery
Talking Mats lW specific situationstheyare more motivated to
carers' perceptio ___ appropriatelyand make changes where
a "'VII;:7. pOSSible.
Which clientgroupsare
Matscan be adap,ted foranyone who needsto
Although initiallyintended for AAC users, Talking
Talking Mats most
suitablefor? addresscomplex issues.
14 .SPEECH & LANGUAGETHERAPY IN PRACTICE ALITUMN1998
ISSN (online) 2045-6174 www.speechmag.com