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 Helen Beltran for this thought provoking blog.

I am an Accredited Talking Mats Trainer and have just finished a great week of training in my local area, Inverclyde, Scotland. This was the first time I had given out symbol sets to everyone who completed the training. What difference did it make?

Everyone was able to see the symbol sets during the training and was really positive about the images and the design. I was concerned at the time that this would stop them really engaging with the process and individualising their mat. I was so pleased when they came back with videos that showed that they had selected the most appropriate options for their communication partner, they had removed those that were too abstract, they had thought about using photos, they had added symbols they had produced themselves. They had made the resources their own!

We talked about this as a group and all the participants felt that the symbol sets were going to allow them to get going with Talking Mats. They would then develop their bank of symbols, by making their own and buying further packs. Some participants told us that they felt having the symbol sets was allowing them to bring supportive colleagues on board who had not yet done the training and was combatting the negative attitudes of the vocal few who had the ‘not more work for us to do’ attitude!

They left with their symbol sets – full of ideas, not just about Talking Mats but about offering choice, hearing the individual’s voice, reducing vulnerability, relationship building and empowerment.

It has often struck me that some people are very much at home making picture resources and making their communication more visual, while others find it a real challenge. Is it reasonable for us to expect everyone to produce their own resources from scratch? Is the barrier to the use of visual communication the making of the resources, rather than the motivation to use them? On the other hand, is the making of the resources the only way to make sure that the supports meet the individual’s needs? What about the costs involved in buying in? Do those who are embracing visual communication need help with resources in order to spread good practice?

Food for thought?

We are very grateful to Rhona Matthews for sending us this moving blog.

‘‘I met with Katie, the worker at Perth Young Carers who did the Talking Mats training and she told me this story:

It is recognised that there are many positive outcomes from being a carer.
For some young people helping care for a sibling can bring confidence, develop feelings of closeness to family and increase self esteem. However it can also add stresses and strains. Expressing frustrations or anger can be difficult and feel like a betrayal.
Using Talking Mats can make it easier to say the things that might cause upset. Using the Children and Young Person’s resource, a young person disclosed to a worker that the one aspect she was not happy about when helping look after her brother, was administering medication. She had seen this being done in hospital by injection and did not like the thought of having to do it. She was happy with all other aspects of helping with his care. The worker fed this back to her parents and they all agreed not to expect her to do this.
The worker felt that this issue would not have been highlighted without the Talking Mats.”

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

Talking Mats has adopted day 69 of the justice for LB Campaign. This campaign was started was after Connor Sparrowhawk drowned in the bath whilst staying in  an assessment treatment unit .  In the words of his mum Connor was ‘a beautiful, hilarious and loved beyond words dude’.  So, after decades of trying to improve services for people with learning disability, closing the long stay hospitals, bringing in person centred approaches, we are left in 2014 with huge inequalities in the health and life opportunities  for people with learning disability and life’s like Connor are cut short in such a shocking, unnecessary and untimely manner.

How many more tragic deaths are we going to see before residential services for people with learning disability are going to change?  We need to see at the heart of  service culture an ability to really listen , put the views of the patient at the heart of planning and see the families as key partners. Sometimes I think people see listening as a ‘soft issue’. Other things get measured but does the quality of listening ever get measured? It should because in my view it is a critical patient safety issue.

Over the last few years I have had the privileged of working with a diverse group of people with a range of communication support needs. They have developed an interactive workbook for NHS Education Scotland. They share their experiences of contact with services to help staff understand how to improve communication and listening skills. They created 10 vision statements for staff of the things that were key to them. They told powerful personal stories to illustrate those statements. The stories illustrate both good and bad practice. You can download the free resource at http://goo.gl/QdOOev .

Listening to people what strikes me time and time again is the lottery of service delivery. There are some great stories where people have received quality treatment and interaction but that is not universal for there are stories where you are left questioning the compassion and humanity of staff in so called ‘caring’ roles. The question for all of us is how we shift the culture so that we can all experience a person centred and listening health service. I hope the energy and impetus of #107 campaign ignites the flame of change so that ‘all dudes’ gets a safe and quality service. If you want to join the campaign then please follow @justiceforLB .

Using Talking Mats with Tony, a 53 year old man with learning disability and dementia. A guest blog by Rebecca Leighton  Specialist Speech and Language Therapist and Consultant for elenbi-uk 

“When I change I will be different” 

Tony was referred to me for Speech and Language Therapy around 6 months after being diagnosed with mixed dementia.  Dementia was having many effects on him but a key impact was communication difficulties: one of these difficulties was dysarthria (for him, this meant slow, slurred, effortful speech and difficulty maintaining enough breath support to finish his sentences) and  another word-finding problems (difficulty remembering and producing the words he wanted to say – like the “tip of your tongue” phenomenon we all get from time to time, but occurring in most of Tony’s sentences).  These two communication difficulties combined made talking very tiring and frustrating for him.

When I first met Tony, one of my aims was to find out what he wanted to achieve with Speech and Language Therapy.  We discussed this but it was tiring for Tony and it became clear very quickly that using words alone was not helpful.  It also became clear in that first session that although Tony was concerned about his speech, he was more concerned about his future and other areas of his life. He was worried about how he would enjoy life with dementia. He knew he would get worse and he wanted to know how he and his family would cope with that.  Tony said “When I change I will be different. What will I do with myself?”

I introduced Talking Mats to Tony at our next session, suggesting that it would be a way of exploring what he was worried about in terms of his overall health and wellbeing and also  what he might want from Speech and Language Therapy.  We did four Mats over the course of two sessions:

Mat 1: Starter topic (food). Tony managed a three-point scale easily (“like” “dislike” and “not sure”) and told me “This is alright, its easy. I can talk if I want. But I don’t have to.”

Mat 2: “My worries”.  Tony used a three point scale to indicate whether he was “not worried”, “a bit worried” or “very worried” about a range of aspects of his life and future.  We found that Tony’s main worry was what he would do with his time as his dementia progressed.

Mat 3: “Activities with dementia” – a sub-mat based on Tony’s main worry identified in Mat 2. This was done jointly with his advisor, Sabira, from his local dementia support service, who planned the mat with me to ensure it covered all the options Tony had available to him locally. The mat revealed that Tony was already attending a well-being café but wanted to try other well-being cafes too, to meet more people.  He was keen to try the singing group and also felt that his family needed support.  Sabira commented that she thought Talking Mats should be used more with people with dementia and she intended to explore this within her own service.

Mat 4: “What I want help with from Speech and Language Therapy”.  Again we used a three point scale, this time to indicate “yes”, “no” and “maybe” to possible goals for Tony. Options included assessment, therapy and advice. We chatted around each topic, giving Tony more information on each possibility and discussing if and how it could benefit him. Tony made informed choices around each option, and made the decision to start by creating a Life Story.

With Talking Mats, Tony has been able to give his full views on some very difficult topics for him. He has done so in a way which has reduced the demand on his speech, which made the discussion easier and less tiring for him. He has taken control of his Speech and Language Therapy care and has made informed decisions about his therapy goals.  Perhaps more importantly he has taken control of his future and made informed choices about what he wants for himself and his family for the rest of his life.

Talking Mats could be used by many services for people with dementia.  Imagine how empowered people with dementia would be, for example, if their social worker or dementia adviser were able to use Talking Mats with them to identify their needs and wishes and help them choose what they want for their present and future. What better way to involve people in their own care?

The only caveat? Get in there early. Empower people to tell their story while they are still able to use pictures and words to do so.  Dementia can steal these skills, burdening families with making decisions on behalf of their loved ones.  As a daughter, mother, wife and sister myself, I know I would feel much more at ease with making a decision for my relative with prior knowledge of what they themselves would have wanted. Talking Mats is one way of finding that out.

In the Health and Well-being resource, we have provided four sets of symbols to help people consider how they feel about their communication. Because communication is  complex and often abstract, it can be particularly difficult for people to express their views about it, especially if they have existing communication difficulties. To make this easier, we have divided communication into four topics:

• Expression
• Understanding
• Learning and thinking
• Relationships.

In the following example, I show how each topic can be used to build up a picture of how someone feels about different aspects of their communication. I worked with Kate, a 42 year old woman who had a stroke which left her with severe expressive and receptive aphasia. She was able to communicate through vocalisations and gestures. She could sometimes draw or write down words and needed to point to ‘yes/no’ in order to reliably answer closed questions. Following discharge from hospital, I used Talking Mats with Kate to find out how she felt about her communication. I started with the ‘communication – expression’ topic and found that she felt that she was having lots of difficulties making herself understood, particularly on the phone and in group situations:

I then explored how Kate felt about understanding what people were saying to her. Kate was able to tell me that she found it easier to understand people on a one to one basis rather than in a group setting. She indicated that it really helped her if people used gestures or wrote things down. Her main difficulty was understanding people on the phone, and in fact she had stopped answering the phone altogether (see mat below).

We went on to do a mat about Kate’s learning and thinking. In this set, there are symbols which cover higher level language activities such as reading, problem solving and organisation. When we talked about these areas, Kate was able to tell me about the things she was finding most problematic, but could also identify some things that she felt she could still manage (such as calculations and reading newspapers).

I then asked Kate how she felt about communicating with different people in her life. This mat shows that Kate found talking to her husband and her parents (who lived quite far away) particularly difficult.

As a result of doing these mats, we were able to target the things that mattered most to Kate in relation to her communication, and came up with the following actions:
1. Kate felt that her husband needed support and information, so we spent time working with him, showing him the best ways to support Kate’s communication.
2. Because Kate’s parents lived quite far away, she could only contact them using the phone, which was very difficult. We worked on getting Skype set up so that Kate could communicate with her family using all the modes available to her.
By splitting communication into different sub mats, Kate was able to think about different aspects of her communication and identify the things that she found most challenging. Together we began to work out some ways to help her overcome her difficulties.
Use the communication symbols to find out what people want to work on and use a collaborative approach to establish some goals to work on in therapy. I used the original Talking Mats when I explored  Kate’s communication with her, but you could do the same with Digital Talking Mats. Find out more about it here.

When people have been in hospital for a period of time, for whatever reason, consideration needs to be given to discharge planning. There are often concerns about what a person may manage to do independently when they get home, and this often has an impact on where people are discharged to and what type of support they might need.
The ‘looking after yourself’ symbol sets in the health and well-being resource provide a good starting point for exploring some of these issues. This set is made up of three topic sets:

• Domestic life
• Self-care
• Work/education

I used these when I worked with a woman (Ruby) who had severe receptive and expressive aphasia. She had been discharged from hospital with a care package (carers came in three times a day to help her with personal care, meal time preparation and housework). Ruby had difficulty communicating through speech but was able to use Talking Mats effectively to express her views. I used the ‘domestic life’ symbols to find out how Ruby felt about managing the daily running of the household. Ruby was able to tell me that she felt she could now do more things around the house, such as hoovering and the laundry. She was ‘unsure’ about cooking and shopping, but indicated that these were areas that she wanted to work on.

Using Talking Mats, Ruby was able to tell me that she wanted to try to do more things for herself. We used photographs of the completed mats to discuss these issues in more detail with Ruby’s social worker and her husband. Initially, Ruby’s husband was hesitant about her doing more things around the house, but seeing the mat in front of him meant that he really listened to her views and felt happier about her taking risks and trying things for herself. As a result of our discussions, Ruby’s social worker reviewed her care package. She reduced the daily visits by carers and Ruby was given support from the rehabilitation team to help her work on preparing meals. Her husband arranged for a friend to take her to the supermarket once a week so that she felt more in control of the cooking. Use of Talking Mats meant that Ruby was really involved in setting her rehabilitation goals and ensured that her views were heard when her care package was reviewed.
The ‘looking after yourself’ symbols can be used to include people with communication difficulties in the decision making process. This is particularly important given the current legislative drive to promote self-directed support. Find out more about how to use Talking Mats by signing up for a training course at Talking Mats.

In a previous Blog, Joan talked about the four purposes of communication (Light 1988):
1. Expression of needs and wants
2. Information transfer
3. Social closeness
4. Social etiquette
Social closeness can often be overlooked when we support people with communication difficulties, as there can be a temptation to focus on what some see as the ‘important things’ – helping people to express their needs and wants or to transfer information. Social closeness is the glue which binds us together and helps us to form and maintain relationships. It’s really important that we establish this before we start exploring some of the difficult issues that many of the people we are working with face. In my work with people with severe aphasia, I spend time getting to know what matters to them and finding out what their interests are. This is a crucial part of building a relationship with the person and their family. It also provides a much more concrete starting point for beginning to explore rehabilitation goals, as this example shows:
When working with Jack (a man with severe receptive and expressive aphasia), I started by using Talking Mats to ask him how he felt about leisure activities. This was a great way to get to know Jack as a person and to find out his interests. During our conversation, Jack told me that he enjoyed going out for a drink but hated shopping and bingo – and we all had a laugh as he told me this. Jack also told me that he used to like ten pin bowling. He pointed to his leg to indicate that this was something he could no longer participate in as he was now in a wheelchair. I could see that this was important to Jack, so we talked about possible ways round his physical difficulties. Jack agreed that this was something he could work on with the help of his family and the rehabilitation team.

Given that Jack had severe receptive aphasia, if I had started by using Talking Mats to identify specific problems (using a top scale of ‘managing’ and ‘not managing’) as part of the goal setting process, it is highly likely that Jack would have found this too abstract and difficult to engage in. By using the more concrete topic of leisure (with a top scale of ‘like’/’dislike’), Jack was able to reflect on his life since his stroke and tell me how he felt about his restricted physical abilities. I was also able to build up a picture of him as a person and we had fun at the same time.

When using the Health and well-being resource, think about the person you are working with in relation to the ideas and concepts that they can cope with. Exploring leisure activities is a great way to start as it means you can establish rapport by finding out what matters to them.

Have a look at this Blog to see how other people have used a topic such as leisure to build social closeness.