Methods of communication

Hi All- Last post for this clinic!
I have had an interesting communication experience over the last few weeks of this clinic. I was asked to treat a 40 year old patient who has locked in syndrome. In handover, I learned he had a very severe pontine stroke about 2 years ago which left him with only lateral movement of his eyes. Since then he has regained full movement of his eyes and with a lot of effort can say some words, though they are not always understandable even to his wife. I was told his cognition is excellent and he is a very sociable and funny person. I was quite nervous because I thought I was going to find communication with him very difficult and I didn’t want to offend him by not being able to understand what he was trying to tell me. The patients wife showed me a board that he uses to communicate which is essentially a square piece of paper with a big square in the middle cut out. Around the outside of the square at each corner and halfway along the sides, are blocks of letters of the alphabet. The patient would look toward a block of characters and then I would read the letters in that block while watching him through the big square in the middle and he would blink at the letter he wanted. We would keep going until he had spelled out what he wanted to tell me. This process is the main way he communicates. At first I found it very difficult to co-ordinate watching the patient, reading the letters, remembering the letters that had come beforehand and then remembering the words that he had already spelt out in the sentence – all at once!! I also felt that because communication took so long, it might look like I couldn’t finish the treatment sessions which were actually quite simple muscle stretches and passive movements in a timely manner. I also saw how frustrated it could make the patient in the times when he had spelled out most of a sentence and I forgot the first words… - although he was very patient and usually just laughed at me and then started again. But, over the treatments I saw him for; I became much better at this and could eventually pre-empt some of the words he was spelling which he found helpful so that he didn’t have to spell everything out in full. On the last session that I saw this patient for, his wife explained to me a new method of communication that they were about to trial where a computer would read out the letters of the keyboard and the patient would use his thumb – which he has movement of – to click at the correct letter. His computer works just like a normal computer but this is going to be his method of input. After having this experience, I have learned that no process should be considered too difficult when it comes to letting a person communicate with others and that patience should be given because alternative forms of communication can be quite time consuming. I realize that are many different methods of communication, some of which are very creative and that it just takes a while to learn which is the best for each individual to use.
Mel