We are launching our fantastic eating and drinking resource to support shared decision making. This has been co-produced with the help of  people with eating and drinking difficulties and a range of different professionals. The resource is designed to help people think about, discuss and make informed decisions about how to manage their eating and drinking more safely. People with eating and drinking difficulties should initially be assessed by a qualified Speech and Language Therapist and Dietitian who will recommend appropriate strategies to help them eat and drink safely. This resource is particularly useful in helping people understand the effect that their eating and drinking difficulties can have on their health. It also helps people talk about how they feel about recommended strategies.
When discussing eating and drinking, there are many issues to consider. We have provided symbols under three main topics to help present ideas in a structured way that reduces the likelihood that the person will be influenced.

Click on this image to see it more clearly.

Discussing these topics separately means that people can firstly consider how they feel about different meal times, where they eat and types of food and then think about the impact that their eating and drinking has on their health. It also allows people to have a conversation about some of the suggested strategies and how acceptable these are.

We have run seminars specifically on this new resource in London and Stirling

Contact info@talkingmats.com for further information if you wish to attend a seminar in the future.

Thanks to Lauren Pettit for this thought provoking blog about using Talking Mats in a rehabilitation setting in South Africa to compare goals of adults with aphasia, their Speech and Language Therapists and their significant others.
I am a Speech-Language Therapist in Johannesburg, South Africa and I work in neuro rehabilitation for people who have had a stroke or head injury. Over the past few years, I have been inspired to learn more about implementing communication modes to assist people to participate effectively in various communication interactions.
Talking Mats™ is such a wonderful tool that enables people to communicate so many things, from their needs and desires, to engaging in higher level conversations. I have seen the benefits of this tool used in a rehabilitative setting. I recently completed my dissertation with the Centre for Augmentative and Alternative Communication (CAAC) at the University of Pretoria, in South Africa.
The study included adults with aphasia who were still attending therapy at least 6 months after their stroke and were working on activities and tasks in various therapies, for example: Occupational Therapy, Physiotherapy, Speech-Language Therapy, therapies. I wanted to understand what was important for them to work on in rehabilitation to improve in various areas of life. Some of the adults with aphasia had very little or no speech, others had difficulty expressing themselves and finding the appropriate words to use in a phrase or sentence. Talking Mats™ was therefore used to assist them to rate important life areas. The life areas (activities and participation domains) were identified by the International Classification of Functioning, Health and Disability (ICF). This classification system was created by the World Health Organisation (WHO) and may guide therapy assessment and management. The areas were depicted as symbols with a supplemented written word on each card. These nine cards were: Domestic Life, Relationships, Work and Education, Leisure or Spare time, Self Care, Learning and Thinking, Coping, Communication, and Mobility. The adults with aphasia were asked what was important to them to work on in rehabilitation. The adult with aphasia could place the card under Yes, Maybe or No on the velcro mat and provide a comment if he/she wished or was able to. The Speech-Language Therapists who worked with the adults with aphasia and their significant others (a family member/friend or carer, who knew the person well) were also included in the study. They were asked to identify which areas they thought were important for the adult with aphasia to still work on in therapy.

(Click on graphs to see clearly)

It was very interesting to see varied opinions in the results. Six of the areas received similar ratings from all the participants and Communication was highlighted as an important area to work on by all. There were statistical differences found for the following domains: Work and Education, Leisure or spare time and Self Care. The adults with aphasia wanted to work on Leisure or Spare time and Self Care, however, Work and Education was not important to them to work on in rehabilitation, whereas the Speech-Language Therapists rated Work and Education as important for the adults with aphasia to work on. Significant others did not rate these domains as important.
This study gave a glimpse into how some rehabilitation teams are currently communicating and working together and that very often, the people who have difficulties expressing themselves are perhaps not always given the time and space to understand the therapy plan and identify and communicate their individual therapy needs. This needs to be explored further. Talking Mats™ provided a structure and gave the adults with aphasia a ‘voice’ and the opportunity to engage in this complex communicative interaction. I am in the process of sharing the results from the study with the participants. I have encouraged them to sit together in their teams and identify areas that could currently be focussed on in their therapy. Many participants were eager to discuss the results after the interviews were conducted and were interested in the concept of prioritising their rehabilitation needs. I hope they see their participation in this study as the opportunity to further engage in their rehabilitation needs and that it gives them the confidence to participate more fully in many other areas of their lives that they identified as important.
I would so appreciate your thoughts and input. Please respond to Lauren lolpettit@gmail.com

We’re delighted that Andrea Powell, an Occupational therapist in Edinburgh has written a Blog for us about her experiences of being involved in group work with people who use AAC.

As a student occupational therapist, I worked part time as a support worker with an amazing lady Jennifer, (Jennifer is a pseudonym) Jennifer just happened to use an iPad to communicate. At this time I was about to commence my final year studies and was required to research and write a dissertation on a subject of interest. The lightning bolt of inspiration came when I, with Jennifer attended a weekly AAC user support group which was run and organised by a group of SLT’s.

The group was a wonderful resource that truly benefited the people who used it. I witnessed how much Jennifer valued spending time chatting with friends who also used an AAC device and who understood the unwritten rules of engagement. Such as patience while I set up my speech, don’t look at my screen while decide what I want to say etc. Her confidence in using different types of conversation grew while attending the group. It encouraged her to add to her already wide and variety vocabulary. As her support worker I also valued the opportunity to gain access to training on how to use her AAC and how I could provide better support to her.

I began reading around AAC and how people integrate of devices into their lives.  I was however shocked to find that the wonderful group Jennifer attended was a rare occurrence for many users. The more I read, the more I realised that many users struggled to continue using an AAC device due to lack of support, access to trained professionals and most did not have wonderful resources like user support groups.

As an OT I was interested to explore the role in which I would play within AAC provision and found that as an OT I would be mainly providing support and advice on positioning, accessing devices and ergonomic type support.

However I felt that as an OT we have many more skills that didn’t appear to be to be getting utilised, within in my dissertation proposal I postulated that OT’s could expand their role within AAC to i) collaborating on assessments for AAC; ii) training on devices once they have been issued to users; and, iii) running and facilitating groups for AAC users and communications partners in the community.

OT’s are highly trained specialists skilled at understanding what is achievable and realistic for an individual. Occupational therapists assess individuals holistically in order to establish realistic and manageable goals which can be graded and adapted to suit the individual. Through the utilisation of appropriate grading of an occupation, a user can experience success and therefore less failure and frustration, ensuring the challenge is set at the appropriate level for the individual concerned (Park 2009).

Running and facilitating groups as a therapeutic tool is something that occupational therapists have been doing since the earliest days of the profession and groups are now utilised in many areas of practice (Howe and Schwartzberg 2001). By continuing this tradition, occupational therapists are well placed to take the lead in running and facilitating groups for AAC users, integrating social and community activities into the groups, for example, meeting in local shops to provide real life experience of interactions and, importantly, promoting the use of AAC to the general public. There are similar projects being attempted in Motherwell to increase the awareness of Dementia and make local businesses “Dementia friendly” (Shafii and Crockett 2013). Providing groups for AAC users not only enables them to learn how to use their devices, but also provides a support network of other users and communication partners.

I feel that if the skills of an OT were utilised in more than ergonomics then more positive outcomes could be seen for the user of AAC. I believe that if there were more OT’s taking on additional roles within AAC provision it could help reduce the pressure for SLT’s and the waiting lists to see SLT’s. It would also enable more users to be assessed to use AAC.

Many thanks to Helen Paterson, one of our accredited trainers for this fascinating blog.

Now that Talking Mats is accessible in a digital format, the Talking Mats team are often asked ‘Can it be used on an eye gaze device?’ . Of course, for those who use eye pointing reliably, they can use a standard Talking Mat, but there are those individuals with whom we work with who may want to use their eye gaze device to use a Talking Mat, and who find the digital format more accessible. We would suggest that this is only done with a client who is already familiar with eye gaze , due to the extra effort required both to use eye gaze and to make decisions when using a mat. There are many other access methods with which you could use and access Talking Mats Pro, such as a head mouse, chin joystick or touch screen, but for this blog we will focus upon eye gaze. Here’s how we made it possible, and I am sure there may be other ways which we would love to hear about!

1. To use Talking Mats Pro directly using eye gaze the person really needs to be calibrated on a device, and they require a level of calibration that is good enough that they are able to access a mouse emulator or Gaze selection on Tobii.
2. You must ensure that the mouse emulation or Gaze selection features are set up and the person understands what the features are and what they mean e.g: left click, drag and double click.
3. Open up Talking Mats pro on your account.
4. You will need to select the topic, topscales and symbols for your client, as this will make it easier with less work for your client, although this is something you would do anyway as the person facilitating the mat.
5. Now go through the question and the topscales as you usually would and explain them to your client.
6. Select the first symbol and place it on the mat where they can see it.

This is where the 2 systems differ:

Mouse emulation: In mouse emulation mode, the user is emulating and controlling a mouse pointer on the screen. This function is available with software such as: Tobii Gaze Interaction in Mouse Emulation Mode (shown above), Alea Intelligaze, Eye Tribe with Dwell Clicker, Tellus 4 with TM4 eye tech, or the Windows App within the Sensory Software’s The Grid 2 FastTalker2 user.

1. Client first needs to open the mouse function menu by fixing his or her gaze on the small grey icon which will open the mouse menu.
2. Client then fixates gaze to select the drag function (shown above)
3. Then the client will select the symbol s/he wants to move by fixating on it.
4. Once fixated, they symbol will ‘drag’ around the screen with the clients gaze. 5
5. They will then fixate on a point to ‘drop’ it.

See Video

Gaze selection (Tobii):

With Gaze selection (Tobii only) the user can control a Windows desktop with a two step selection method. The first step involves selecting the desired task from the taskbar on the right of the screen. The person looks at it until it changes to white. The person then looks at the part of the screen where they want the task to take place.

1. The client clicks selects drag function at the top of the Menu
2. They then look at the symbol 3
3. They then look where they wish to place the symbol.

This does require some more thinking on the side of the client as they need to look to where they want it to go and they are not just dragging it as they are in mouse emulation mode.

See video

For individuals who do not have a calibration good enough to use mouse emulation or gaze selection, it is a little more complex. A Talking Mat could be emulated from software such as The Grid 2 or Communicator, but it would not involve the software from Talking Mats Pro or dragging of symbols and moving them to where the person wants them to go.

Thanks to Andrea  McQueen from Australia for this lovely blog describing the Good Things Project which shows how good communication is central to active participation for people with intellectual disabilities

Across the world, many thousands of people with intellectual disabilities live in group homes. These are houses in the community shared by about four to six people with disabilities. Many of these people have communication difficulties of various sorts.
Communication is essential to many activities both within the home (e.g. making a shopping list, choosing what to watch on TV, letting your house mates know when you need some space) and beyond (e.g. developing and maintaining friendships; participation in education, employment and leisure). For many group home residents, participation in these activities relies on access to appropriate augmentative communication systems, and to trained staff who can support their use.
In twenty years working as a speech pathologist in Australia I have been in and out of a lot of group homes. Some do things better than others. Some value communication more than others. Some group home staff routinely use augmentative communication systems, such as Talking Mats, Key Word Sign and pictorial timetables. Unfortunately many do not. Each time I leave a group home, I ask myself the same question: “Could I live here?”
When I first came across the Roydon Street group home here in Melbourne I was impressed. This is a house where communication is respected, where people are listened to, and where genuine choices are offered. It’s not perfect, but it passes my simple test – it is a place where I could imagine living a good life.
I wanted to share the philosophies and practices of Roydon Street around the world. I hoped to influence other group homes to adopt the same simple strategies for their residents. So I sought funding and made a video – Good Things.
The Good Things video aims to show how simple communication strategies can contribute to a good quality of life for people with intellectual disabilities in group homes. It demonstrates how a culture of respect and autonomy can develop when staff understand how to listen to clients and support their communication methods. It shows what is possible in a sector that gets a lot of negative publicity.
Good Things was funded by the Victorian Department of Human Services, and the closed captions on the video were funded by the City of Bayside. The video is the result of a partnership of many agencies and individuals. Special thanks to the residents and staff at Roydon Street. Good Things was released on YouTube in March 2014, and to date has had more than 800 views in 17 countries (not quite keeping pace with Lady Gaga!). It’s a small project, but I hope it has made a difference. I know the team at Talking Mats shares the passion for improving the lives of people wherever they live, and I would love to hear from others with an interest in this area.
Click here to see the Good Things video
Andrea McQueen
Inner South Communication Service
Email: amcqueen@cbchs.org.au
Twitter: @aj_mcq

We are delighted with the response to our new Talking Mats symbols. They created a real buzz at the ISAAC (International Society  of Augmentative and Alternative Communication) Conference in Lisbon last week.” Its so good to see something fresh and engaging” , “These are awesome”

Over the past few years we have been looking at symbols in a new way and have used our specialist skills from clinical practice, research and language structure to underpin their development. These skills, in partnership with a leading comic artist, www.adammurphy.com , have enabled us to design our symbols, making sure that they are:

• Unique
• Attractive and fun
• Simple but represent concepts clearly
• Distinguish between concrete and abstract concepts
• Show full body, not stick figures
• Acceptable in terms of  age and ethnicity
• Balanced between male and female
• Provide additional visual clues within topics to support understanding

Talking Mats does not require people to select and ‘name’ symbols – the important feature is that the symbols act as a support to hang meaning on. In this way people can understand and use the symbols to express their views .

To determine the size and colour of the symbols, we have used a pragmatic approach as follows:

A search of the literature showed that very little empirical research has been written about optimal symbol size and colour for different client groups. However several leading graphic and cartoon designers use yellow as this is easily recognisable, attractive and ethnically neutral e.g. Simpsons, Lego

• Our artist advised us that cool colours such as blue recede into the background visually whereas warm colours such as yellow stand out more
• We believe it is important to include text as this provides additional input for many people e.g. many people with dementia can read.
• From discussion with colleagues and reading learning disability literature we decided that  Arial, san serif point 14 would be the clearest font
• We experimented with various sizes, using very large symbols on one dementia project. However we found that very large symbols are too distracting and limit the number of symbols that can be used on a mat. Following piloting with older people in care homes we determined that the optimal size for using with Talking Mats is 5.5 square cm.
• We ran focus group discussions with speech and language therapists, people with learning disability, people with aphasia and people with dementia. The focus groups presented participants with symbols of different styles, size and colours. The resulting responses plus our literature search led us to the current symbols in terms of design, size and colour.
• We then piloted the symbols in several settings including a day centre with adults with complex physical and cognitive disabilities, a care home with people with dementia and a secondary school with children with additional support needs. In all of these setting almost all participants were able to see, recognise and use the symbols appropriately.
• We made a conscious decision not use photos because photos often have too much detail on the one hand or conversely can be too specific… but that’s a topic for another blog!

We are constantly extending the range of symbols and are currently working on a resource for helping people to consider their Eating and Drinking.  We are also working on providing additional visual clues within topics to help people understand concept more easily e.g. emotions are represented within a cloud border. e.g this poor guy is feeling guilty

We are really excited that our new symbols are now being used by 2 organisations outside the field of disability to help students and graduates reflect on their skills,strengths and weaknesses.

 For further information click here

Angela is a speech and language therapist in Northern Ireland where she works with people with learning disabilities. She worked with John who had some difficulties with eating and drinking. Together they used Talking Mats to help John understand his risk of choking and identify foods which were easy or difficult to eat. Watch this film clip where John describes how Talking Mats helped him to understand and manage his risk of choking.

John’s DVD

My name is Karin Torgny, I’m from Sweden. My background is in journalism and culture studies. I used to work in “The Development Centre for Double Exposure” for many years, and our mission was to improve and spread knowledge about violence against women with disabilities. My special interest during these years was AAC. Today I work for Unicef and in different projects on human rights issues.

A year ago I did my accredited Talking Mats training in Stirling, Scotland. Since then I have given my first course in using Talking Mats when talking about abuse and harm. It was a great experience and an opportunity to work with an enthusiastic group of women who were open and willing to communicate using symbols. They are all in an organisation working with girls/women with intellectual disability exposed to violence and oppression in the name of honour.

I think Talking Mats is a good tool when approaching difficult subjects and I hope to run more courses like this in Sweden in the future. Lately I was interviewed on the Swedish Radio and talked about the use and possibilities with Talking Mats when someone is exposed to harm and abuse.

For those who know Swedish (!), here is a link to that program, http://t.sr.se/1mxZv9W

I am also curious if someone else is doing something similar. If so I would be interested to know more. Send an e-mail to: karin.torgny@gmail.com

Have a look at how Talking Mats has been used in Scotland to support people with a learning disability to disclose issues of concern: Survivor Scotland

Congratulations to our 5 new accredited trainers from Edinburgh City Council , Lothian NHS, Perth Kinross Council and SENSE Scotland

We had a great two days working together, exploring the Talking Mats framework and thinking about skills in terms of training and implementation of the Mats. Lots of chat but some key thoughts emerged that are worth sharing

• Keep calm with Talking Mats and have a blether
• Talking Mats gives the thinker the power to say ‘No’
• Open questions create open dialogue
• Children do but don’t get enough time to say
• Recap; Talking Mats provide a visual summary of the conversation
• It is easy to feel drowned out by other voices Talking Mats keeps the focus on the person
• It is good to have 1 to 1 time and not just when things go wrong
• The health and being resource is a perfect fit for the outcomes focused approach

There were lots of exciting ideas for future projects and further blogs which will expand on these ideas a bit more. So watch this space as the new trainers develop their ideas more.

If you are interested in becoming an accredited trainer click here

To mark Dementia Awareness week the Talking Mats team is keen to provide family training for relatives who care for someone with a communication difficulty.

Thanks to a generous donation from Miss Hendry Charitable Trust and support from Alzheimer Scotland, training has been carried out with family members at the Clydebank Alzheimer Scotland Resource Centre. Eight people who care for a relative with dementia (6 caring for a spouse and 2 caring for a parent) and one member of staff attended. None of the participants knew about Talking Mats before the training. They all cared for people who had difficulty expressing themselves and several told the group about the frustrations and despair they sometimes felt.

The training was carried out over 2 sessions.
Session 1 included an explanation to the background and purpose of Talking Mats, a demonstration, watching and discussing DVD examples, hands on practice, discussion of topics to be used at home with their relative and planning for next session.
Each participant was given a set of materials and by the end of the day all participants had understood the principles involved in Talking Mats and had gained the skills required to use it with their relative. They all said how much they had enjoyed the day and how much they had gained from it. They all committed to trying it with their relative and to bringing back their views to the follow up session. Each participant was given a post-it note at the end of the day and was asked to write any comments- positive or negative about the day.

Some of the comments:
• This was a very positive course today. It has made me feel very hopeful about establishing a time of coherent dialogue with my mother – albeit in a focused way and also in providing a tool for her to communicate in a simple way, her own thoughts, Thank you.
• Informative, informal, surprising. I enjoyed the course and felt I had gained from it.
• Could be a useful tool. Can’t wait to try it with my wife. Thank you.
• The course was very informative and well worth the time spent. Talking Mats is a very simple idea which seems to be working very well. I’m looking forward to trying it out and hearing how the others coped and what the outcomes will be.
• This was a very informative day and hopefully gives us a great way of communicating to find out my husband’s views on subjects.

The participants were assured that they could get ongoing support by phone or email and the staff member at the resource offered to provide local support.

Six participants plus two staff came to the second session. The others were unable to attend due to their relative being unwell. We had lively and helpful discussions where each person shared their own personal stories of how they had used Talking Mats and what it meant for them.
Overall they felt that Talking Mats was a powerful and helpful tool and that it gave them quality time together with their relative with dementia. The following comments illustrate this:
– small changes made a big difference
– It gives me time to sit down and listen to him
– It slows you down which is needed with someone with dementia
– It helps me know where he is at the moment
– It showed my husband the things he CAN do rather than what he CAN’T do

Relatives found out some things about their partner that they didn’t know e.g. one person with dementia had revealed that they didn’t like having the radio on all the time; another had toothache which the partner was unaware of; another said that food had become tasteless and he no longer enjoyed mealtimes as a result. The relatives were all able to do something as a result to help the situations – e.g. reduce the background noise of the radio, make a dental appointment, add more spice to their cooking.
One couple now use Talking Mats every few days on a regular basis to help the person with dementia think about issues and compare his mood from week to week
– He always feels up after he’s done a Talking Mat
This couple had also given a demonstration of using Talking Mats to a family meeting at the resource centre

Overall the participants found Talking Mats very helpful although two felt it had not been successful. We discussed the reasons for this and the group were very supportive and suggested that the staff could help by introducing Talking Mats as a group activity at the resource centre where these two people could be included. The staff at the centre were also very positive and plan to use Talking Mats both with individual people and with groups.

Overall it was agreed that Talking Mats is a very useful tool both for individual families and for dementia centres. We discussed future plans for individuals and also for the centre. This included designing a Talking Mat to discuss football and another to allow the people with dementia who attend the centre to be involved in planning the centre’s new allotment.
We plan to continue our involvement with the Clydebank Resource Centre and are now in the middle of running the same course in other Dementia Resource Centres.

Anyone wishing further information about Talking Mats training for family members, please contact us at info@talkingmats.com