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.

Part 1 highlighted how Talking Mats training can help improve your competency when consulting children and young people. In this part,we are grateful to Anita Devi, Education Consultant for illustrating the key differences between Statements and EHC plans. The changes have been implemented to enable individuals and families be active agents in their own lives rather than passive recipients of services.

Using Talking Mats as a communication tool  enables practitioners to fulfil all stages of the assessment process and contributes to the development of the plan. The differences of the new system under the SEND reforms are illustrated in the table below (double click on the image to see it more clearly):

The local offer provides information on what services children, young people and their families can expect from a range of local agencies, including education, health and social care. Knowing what is out there gives  more choice to individuals and to families.

The Local Offer has two key purposes:

1. To provide clear, comprehensive, accessible and up-to-date information about the available provision and how to access it, and

2. To make provision more responsive to local needs and aspirations by directly involving disabled children and those with SEN and their parents, and service providers in its development and review.

For children and young people, who struggle with communication, this can be quite a challenge. What is required is a communication tool that makes the process real and meaningful. Talking Mats breaks down the dialogue into bite-size chunks and gives the child or young person the space and time to meaningfully express his/her preferences and opinions.

Earlier in the year, Anita Devi & I published an article on “Listening to the learner :seeking the views of children and young people with communication difficulties.” It highlights the importance of creating a listening culture within the learning environment and using all modes of communication available. If we take the time to do this, the child or young person’s perspective will be taken seriously and the unique circumstances of each individual kept central to the process.

Thanks to Fiona Kane from the Alzheimer’s Resource Centre in Clydebank for sharing this lovely story about a visit to a man who had had a stroke. He was able to explain his views and take part in self management without realising it!

“Two of us visited a man who has aphasia. His wife is really struggling to communicate with him. She had been unable to attend the Talking Mats family training. I suggested the Talking Mats and they both agreed to try it out. I thought I would share it with you.

When we arrived the man was snoozing in the chair. He was extremely apprehensive when we first introduced the Talking Mats. However he quickly became very animated and we were able to tune into what he was saying.

A. asked him about gardening and he said he didn’t like gardening. He then invited us out to see his garden, was able to show us where he fell cutting a high hedge and indicated this was the reason why he had stopped working in the garden.

 He told us he didn’t like religion and this was because his Mum was so strict with religion when he was younger.

 He told us he really enjoyed photography and missed that. His wife is now going to buy a digital camera to help him continue with this.

 He also told us that he enjoys listening to the radio but not radio 4 as there is no music.

 His wife was absolutely amazed with the information her husband was able to communicate through the mats and he was able to express how much he enjoyed doing it. He was very animated and walked us out to the door. 

It was a really amazing experience for both of us!”

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 Anita Devi,Education Consultant, for her helpful contribution to this blog.

The implementation of the recent SEND reforms in England requires interdisciplinary teamwork. Integrated assessments will now be carried out in cooperation with the young person and the parents. Capturing the child’s own perspective and recording their views, interests and aspirations is now a statutory requirement. The principles of the SEND Code of Practice state that practitioners should encourage the child or young person, and the child’s parents to participate as fully as possible in the decisions affecting their lives and use a common language to shape educational and other outcomes.

Talking Mats has produced a practical and creative resource – “Consulting Children & Young People” that helps practitioners to ensure that they take account of the SEND Principles at all stages of the assessment process and development of the EHC Plan.

We recognised the need to develop a tool that would give a holistic picture of how a child or young person feels about their lives at home, at school and in their communities. Having a visual framework means that there’s more time for reflection. You can help young people to see their personal strengths and abilities and take time to consider what their problem areas are.  Talking Mats gives greater choice and control about what kind of intervention is required to support them.

Communication is a two way process and the role of the facilitator is crucial. Talking Mats provides training at the following levels:

• Awareness – an introduction to the Talking Mats framework and the development of the CCYP resource.
• Enhanced – a whole day training to equip practitioners to use Talking Mats
• Specialist – In depth training which allows the practitioner to train others in their organisation.

(as stipulated on page 58 of The 2014 SEND Code of Practice for England)

Why not sign up for one of our training courses and learn more about –

    Improving the quality of your engagement

    Creating a visual framework for consultation

    A child centred approach to joint decision making.

Read Part 2 of this blog next week.

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.”

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

I recently fell down the stairs and injured my ankle a few days before I left to visit relatives in Canada. I then had the frustrating experience of having to use a wheelchair to get through 5 airports in one day on my own. It made me realise how it all depends on communication and how reliant I was on the communication skills of the people pushing the wheelchair and how helpless I was when communication went wrong.

I had gone on-line before leaving to pre-book a wheelchair but this was confusing as each airport and airline had different rules.

It started in Edinburgh where I was directed to a calm and very competent young man who told me exactly what was happening, where he was taking me, checking if I wanted to use the ladies room or buy a coffee, helping me get through security and then to the door of the plane where I managed to hop to my seat. ‘Great’ I thought -‘This is going to be a doddle!’

Same thing happened at Heathrow with a lovely woman who chatted all the way – checked if I needed anything and told me that she had been doing this job for several years after her mother had died and absolutely loved helping people. However …. at Boston where I had to go through customs, collect my luggage and recheck in and go through security… That’s when it all went wrong.

The man who came to ‘help’ was a man of few words and despite telling him repeatedly when my next flight was due and that I didn’t have much time, he seemed totally unconcerned. He dumped my case across my knees ( heedless of my injury); he took me to the wrong terminal building despite me asking if we were we going to the Air Canada terminal; he never looked at me or asked if I was OK; he walked incredibly slowly paying no heed to me showing him the time on my boarding pass and the final straw was when he stopped at the corner of one building and said he could go no further as he only worked for transatlantic flights! He then made me get out of the wheelchair and left me to hobble to the Air Canada desk with both my check-in baggage and my hand luggage. By the time I got to the check-in desk the flight had closed and I was told I was too late and I would need to get another flight the day after!

Fortunately the Air Canada staff could see that I was struggling and persuaded the baggage handlers to accept my case as I was ‘disabled’ and I was allowed on the flight….just!

The staff at Toronto and Winnipeg airports were much more helpful but for me it was a real insight into how dependent someone in a wheelchair is and how things can either be made pleasant and smooth or can go horribly …wrong depending on people’s communication.

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