Practical communication skills training: This is to enable patients with speech/language disorders to make maximum use of their residual functions, to develop verbal and non-verbal abilities, to enable patients to effectively make meaningful connections with people around them by the most effective communication methods, and especially to promote the communication skills necessary for the patients’ daily lives. It is suitable for all types of aphasia.
Training principles to promote functional communication skills.
Emphasis is placed on everydayness, transferability and communication and on the use of communication strategies, as follows.
(1) Training of communication strategies.
Let the patient use rhetorical questions, repeat the other person’s words or make requests when receiving information, or even make expressions and movements to make the other person repeat or slow down their speech so that they can receive the information better; learn to synthesize comprehension, capture key words in other people’s words, and may ask others to make a more general explanation of their words or change to a textual comprehension approach. Expression can also be done in a variety of ways, making full use of gestures and expressions as well as drawing pictures, and also using roundabout language for description.
(2) Training of surrogate means.
For some patients with aphasia who have no hope of regaining functional spoken language ability after training, some simple gesture language training can be considered; while for some patients who retain some photo ability, drawing training can be carried out to include written gestures or spoken language as much as possible when using some simple drawings of daily life items or events. Facilitating communication effect method is a commonly used language training method, which transfers the language function to communication effect, and also natural conversation method, emphasizing the therapist’s equal status of conversation, sending and receiving information with the patient, in order to restore the actual communicative ability and achieve natural conversation, allowing the use of various languages such as speaking, writing, gestures, and postures, so that communication can take place. A stack of pictures can be placed face down on the table, and the therapist and the patient alternately touch them without letting the other person see the contents of the pictures in their hands, and then use various expressions (such as name calling, roundabout language, gestural language, pointing to objects, drawing, etc.) to transmit the information to the other person, and the receiver gives appropriate feedback by repeating confirmation, guessing, and repeated questioning.
Training methods to promote practical communication skills are as follows.
(1) Gesture language training: Gesture language not only refers to hand movements, but also includes head and limb movements, emphasizing dynamics, and training starts with common gestures. Therapist demonstration, so that patients understand, so that they imitate, and then the corresponding practice with the figure or object, and then strengthen the application of gestures.
(2) Drawing training: This method is used for patients who have some drawing ability. Before training, tests such as drawing the human body and cartoon understanding can be conducted.
(3) Training and utilization of communication board and communication book: consisting of pictures and words, etc. The training includes understanding and confirmation of pictures, photos, words, and signs; setting the communication context for questioning and pointing to pictures (pointing to words, etc.) response training.
Operation methods and steps.
(1) Place a stack of pictures face down on the table.
(2) The therapist and the patient alternately touch the pictures without letting the other person see the contents of the pictures in their hands.
(3) Use various expressions (e.g., naming, describing, gesturing, writing, etc.) to convey the information to the other person.
(4) The recipient provides appropriate feedback by repeatedly confirming, guessing, and questioning.
Evaluation of the practical communication training method: 5 points for successful transmission of information on the first attempt; 4 points for successful transmission of information after failure to be understood by the recipient on the first attempt; 3 points for successful transmission of information through repeated questioning by the speech therapist or through compensatory means such as gestures and writing; 2 points for incomplete transmission of information through repeated questioning by the speech therapist; 1 point for incomplete transmission of information after repeated efforts 1 point; 0 points for not being able to convey the information.
Effectiveness assessment: The practical communication training scoring method was used to assess the practical communication ability and analyze the effectiveness of rehabilitation. Effective, the score improved by more than 2 points after treatment; effective, the score improved by more than 1 point after treatment; ineffective, the score did not improve after treatment.
Precautions.
(1) The expresser conveys information that the other party does not know.
(2) The means of communication is freely chosen and is not limited to spoken language, but can be written, gestured, drawn, etc.
(3) The expresser and the receiver are on equal footing when communicating, and conversational tasks should be alternated.
(4) Appropriate feedback should be given when the patient is the expresser and the therapist is the receiver to facilitate revision and improvement of the patient’s method of expression.
(5) Adopt the contents of daily communication activities as training topics, and choose training materials close to real life such as objects, photos news reports, etc.
(6) Set up contextual changes that are closer to real life to elicit spontaneous communication responses from patients.