More than talking...

On my current placement I am working with a patient who has quite severe communication difficulties. He is very dysarthric, making his speech difficult to understand and he has problems achieving appropriate volume. He is also totally deaf in his left ear, and has significant hearing loss in his right ear. The main stepping stone to overcome when treating this patient has been dealing with communication, in order to perform the desired treatment. The patient has deteriorated quickly in the past 12 months, and he becomes very frustrated when he can’t relay his message or understand what we tell him. Although we cover communication strategies at university, it is quite challenging dealing with a situation like this.

His wife or parents accompany him to every physiotherapy session, and they assist with communication as required. To overcome this communication barrier, we have used a number of techniques that we have tried out and adapted as required to suit the patient:

- facilitation and contact to show him what is required

- speaking loudly and slowly on his right side

- gestures (his wife showed us the ones that she uses and we employed these)

- if we can’t get our message across, we ask for help from his family, and they tell him

- he has a writing board that can be utilized as required

- limit outside noise

I have been seeing this patient twice a week for an hour at a time for the past month, and over that time have learnt to be able to communicate quite easily with him. Having never worked with a patient like this before, I now feel confident that I can apply the communication techniques used here to other patients. As therapists we need to take time to find out what works for the patient, observe others communicating with the patient and take on board what they do, and we need to be able to think on our feet and adapt as the situation requires. This is also a situation that likely involves a mutildisciplinary approach and we need to liase with speech pathology, OT etc to ensure that the patient receives best possible care and optimal communication is achieved. As students we can often find ourselves talking until we run out of breath, but it is important that we work on developing our physical communication skills as sometimes action truly speak louder than words.