Episode 314: Chantelle Hutchinson: Supporting Adult AAC Users with Acquired Brain Injuries

This week, we share Rachel’s interview with Chantelle Hutchinson (@dysphagiacommunity)! Chantelle is a Speech-Language Pathologist who works with adults with acquired brain injury and progressive neurological conditions. She shares about some of the factors that make working with clients with acquired brain injuries, like traumatic brain injury (TBI) and stroke, unique, including: how AAC needs can be different, the impact of frequently changing communication partners, the value of getting to know the client before writing goals, and more!

Before the interview, Chris and Rachel chat about why podcasting should be considered and supported more often as a form of professional development. When we make education more engaging, it leads to better outcomes and retention!

Key Ideas This Week:

🔑 Some people who have a TBI or stroke may not understand that they are communicating differently or their communication partner is not understanding. This can impact buy-in, because the client may not see much need for the device if they are not aware of the communication breakdowns.

🔑 We don’t always target building awareness about communication breakdowns for a client with a TBI or stroke. It takes a balance, because if a client is totally unaware, it can impact their ability to know when to use strategies (like AAC), but being highly aware of communication difficulties may lead to lower mental health outcomes overall.

🔑 A therapist working with TBI and stroke needs to keep in mind the client’s cognitive profile -  some may never get to the point where they can initiate a conversation, no matter how much you practice the skill. In that situation, try and consider if the client’s needs are being met naturally and how you can best support them given their cognitive profile.

Links from This Week’s Episode:

Talking Mats: https://www.talkingmats.com/

Transcript of the Episode

Please Note: This transcript was generated using speech recognition & AI tools; it may contain some grammatical and/or spelling errors.

00:00:09
Welcome to Talking with Tech. I'm your host, Rachel Madel, joined, as always, by Chris Bugaj. Hey, Chris.

00:00:13
Hey, Rachel. What's going on?

00:00:15
Not much. What you got for me this week?

00:00:18
Well, I have some reflective thoughts that I just want to run past you. You know how we sometimes look through our social media feeds for inspiration or some sort of learning or connecting with people? You know, kind of what's going on on. Oh, there's Rachel. She's talking about whatever it is.

00:00:35
It's syntax or semantics or whatever, right? So I'm flipping through different social media, and I get to see questions kind of frequently about professional learning. Like people ask, hey, I need some professional development. What do you recommend when it comes to AAC? And oftentimes I see lots of sharing of resources, like different courses that are out there, which makes total sense to me, right?

00:01:07
Like, you take the course and you get a certificate, and you and I have made courses, right. That. That resonates. What do you think about the concept of our podcast, or podcasts in general as a form of professional development? Because the reason I want to bring this up is sometimes I see it get referenced, like talking with tech or the Loma podcast or podcasting in general.

00:01:32
When I'm in different circles, you know, different assistant technology circles or other educational circles, I'll see a podcast get referenced. But it's usually not the first thing that jumps in people's minds. They're thinking of some sort of webinar or in person conference, and then podcasting is some sort of, you know, it's like if they're running around the track, they've been lapped like four times before podcasting comes up. And I'm just curious why you think that is. First of all, do you agree with that notion that podcasting seems to be an afterthought when it comes to professional development or.

00:02:08
No, Chris, I think it's grown, and people do think of it in the front of their minds as professional development. What's your take?

00:02:15
I don't think people think of it as professional development. I do think they think of it as a place to learn. And so I think people seek out podcasts because they want to learn, because they want to be inspired, because they want to be entertained. But I don't think that it kind of fits into the category, traditional category of professional development. And I wonder why that is.

00:02:42
I think that maybe podcasts are reasonably new when it comes to just kind of the world, right? It's like podcasts aren't super podcasts are a newer medium for learning, for sure. And I think that just generally speaking, whenever there's something new, it kind of takes a long time for it to kind of trickle into and get boxed into what we would think about as professional development. I think about, like, academia and, like, it's just not as. Maybe respected isn't the right word, but it's like there's a different, it's like a different flavor.

00:03:19
It's kind of like, oh, yeah, podcast.

00:03:21
Like, well, I just want to comment on that breadth of time because it is relational, because I know I'm listening to you say that, and I'm like, podcasting came out in 2005, so we're almost 20 years old in podcasting, right. But in this, I think what you're saying is in the relation to people sitting in a room listening to someone lecture or someone going to a conference and participating in that sort of experience that is, that's been going on for hundreds, more than hundreds of years. Right. So that's why it's just this really small span of time. Is that.

00:04:04
Is that what you're trying to get at?

00:04:05
Yeah. I also think that just, like, podcasts have been around since 2005, but I feel like they're more mainstream now. Like, I feel like even when we started the podcast six years ago, like, it wasn't, I don't know, it wasn't like it is now. Like, I feel like everyone's like, podcast. Yeah.

00:04:21
Here are my favorite podcast. You have a podcast. Cool. I have a podcast. Like, I feel like it's just kind of, like, a lot more common than it was ten years ago, 15 years ago.

00:04:33
So I think that there's that element, too.

00:04:36
Yeah, for sure. So do you think that just given more time, that will change, or is there some other ways we can maybe put our foot on the gas to make that change happen faster if we think that's a change that should happen. And I'm sort of thinking it should. I get so much learning, and I've learned so much from podcasts. I mean, I remember listening to, gosh, just everything.

00:05:02
Like, everything I wanted to learn about, I was like, I'm going to go either get an audiobook and then, or listen to a podcast on it and just try and absorb that information. And it is just, I don't know how I would have got it in other ways. You know, I wouldn't have time to open a book and read it as fast as, you know, listening to it as I'm driving from place to place, you know, and I could easily be in my car 2 hours a day, you know, so that's got to be a way for me to take in information and learn, and it certainly has been. So, what do you think?

00:05:32
Yeah, I mean, I think that I have learned so much like podcasts. Like, if I'm trying to learn something, I'm like, how can I find a podcast if I'm trying to find a doctor? I'm like, I want to find a doctor that's been on a podcast. Like, I'm just like, I really, like, love podcasts, and I feel like they're a really great way to learn. I'm also, like, I love audio and visual, and I'm not, like, into reading and, like, I just love, like, being kind of on the go and, like, moving, moving my body, going on a walk and listening to something.

00:06:06
Cooking dinner and listening to something. And so, like, I of course, love podcasts. Um, you know, and there's so much learning that can happen from a podcast. Um, and I think one of the things that I feel like make podcasts so great for learning is that they're not, they're typically not one person teaching you about something. It's a conversation, right?

00:06:31
It's usually like, I have a guest on and we're talking about something, or I have a co host and we're discussing something. And I feel like it's just a more natural, engaging way for people to learn information. And we talk about this all the time when we do speaking events. We're like, we're not going to just sit here and talk to you and, like, lecture because there's no value in that. You can, you know, go listen to a podcast or YouTube channel or whatever if that's what you want.

00:06:57
But, like, how do we get engagement? And I feel like, you know, maybe you're not able to engage with your audience during a podcast, but at least there's like, you know, you're kind of like sitting and listening to a conversation. And that conversations and storytelling, I feel like, is the best way for people to learn.

00:07:16
So there's a book called Brain Rules by Doctor John Medina. He did research about ways we learn, and the number one way we learn is move. So the idea that you said I go for a walk or I'm doing my dishes or whatever, you know, I'm in the garden and I'm listening to the podcast. The action of doing that stuff while listening helps you remember. And I bet you can remember certain podcasts where you were when you heard that information.

00:07:44
Like, oh, I was walking by this monument or this tree or, you know, I just. I was on a walk when I heard this. So I think there's some, there's some teeth there to what you're saying about moving as opposed to being stationary and watching someone in front of slides go over their slides. Right. Um, let me ask you just something a little.

00:08:06
A little more, Rachel, is do you think there's anything to the fact that you can go to a conference and at the end they give you a code and then you can say you were there, even though you were in the room and you might have been checking your email and not even listening to what the person said. The fact that you're there and you can prove that you're there shows. I'm going to put an air quotes, um, that I learned, you know, or I got my CEO's by logging into a webinar. I mean, I was watching the walking dead and I had the, the sound turned off, but I was logged in. Do you know what I mean?

00:08:38
Like, or I was.

00:08:41
You think there's something I was going to say?

00:08:43
Or. Or I was texting with Chris Bouguet the whole time as I was sitting next to him because we've definitely been in sessions for.

00:08:50
Exactly.

00:08:51
Ah, this ain't good. But, like, let's talk about other things secretly.

00:08:59
For sure. For sure. So is that a great way to measure learning that people were there? No. And is that the notion that we want to propagate?

00:09:08
You know, is that being in the space means you've learned it? And I just feel like that's such an old way of thinking and that there has to be a better way to think about how people can show what they know, either through the creation of some sort of artifact, some sort of reflection of some sort. I feel like that is so much better than, here's the number of hours I've attended. And then podcasting could be in the loop. You know what I mean?

00:09:35
Because then podcasting, it'd just be a source. Because most podcasts don't have a multiple choice test at the end that you take to prove that you learned it. And I get proven in quotes. Right? And I thought about it.

00:09:48
I thought, like, back in the 80 tips cast days, in fact, I built some stuff with the at tips cast days. I built, like, little pamphlets and I used to download the episodes onto cds before Netflix was a thing. And people could rent the cds. Rent. Like, they could sign up for the cds and I'd send it to them in the mail and they'd answer the booklet.

00:10:05
And we had some people do it, but it wasn't wildly popular. And same thing here. Thought about it with talking with tech. Do we invest the time to, even in the world of generative AI, take the show notes or a transcription of our audio, turn it into some sort of. Some sort of multiple choice test, put it up so that people can take it?

00:10:29
Then you could automatically get a certificate saying that you listen to the episode, that you could throw it in your folder to prove that you've done something. Will people do it? Because it seems like I would invest that time in figuring out how to do it if people would do it, but I'm not sure people would do it, so I don't want to invest the time.

00:10:48
I totally hear you. It's unclear if people would do it. I think people listen, but then the whole step of taking a quiz, all that stuff. But I guess we have to do professional development. So it's like, wouldn't that be fun if you could just listen to your favorite podcasts?

00:11:03
And then, I mean, I think you're. We're onto something here. It just, you know, I think the other thing that's been coming up during this discussion, Chris, is we're having something similar going on in my own business, which is we've had some of our Instagram reels go viral, and I've had people reach out to me saying, like, can you put this on YouTube? Because, like, I want to share this during, like, a professional development, but I don't want to share someone's, like, Instagram reel. And so.

00:11:38
Which is valid, right? Like, I also, you know, I wouldn't be. I wouldn't be so opposed to sharing an Instagram reel if it was really good, you know, during a presentation. But I see what the person saying is, like, there's, like, a legitimacy to YouTube. And, like, the moment we say it's from Instagram, it could be literally the same thing, but all of a sudden, it's not.

00:11:58
It's not, you know, as professional, or we can't take the information the same way. Right. So we've been converting some of our top performing Instagram reels into YouTube videos and, like, putting them on my YouTube channel. Cause I do have a YouTube channel. Um, and so it's, like, kind of the same thing.

00:12:14
It's, like, so interesting how these different platforms have different kind of parameters in people's brains around, like, what they are, what they're used for. And, um, I think this kind of leads into this discussion, right, of podcasts is like, oh, yeah. Like, I can learn from a podcast, but, like, it's not professional development, but, like, it kind of is.

00:12:35
That's kind of a rule of thumb I learned long ago is that before you go and make new professional learning, like, if you've made a slide deck, before you go make the next slide deck, take that content and put it out in multiple modalities. So make a video around that slide deck, make audio around that slide deck. And I think that's, um. That's what you're saying, is that, uh. Well, two things I hear you saying.

00:12:58
One is so multimodal approach, where I'm going to put it on Instagram, and I'm going to put it on TikTok and I'm going to put it on YouTube. And we do that with talking with tech. Right. I don't know how many people, we don't advertise it very often, but we have a YouTube channel, and our audio gets automatically fed over to makes a. We've got that all automated.

00:13:18
Automated. Yeah.

00:13:20
So my favorite word. My favorite word.

00:13:23
And every few months, you know, we'll check it and then be like, oh, Luke, the link broke. And then Luke will go and fix it. So. But the point being is that because there's so many different people out there that access things in different ways, the best way to get your content out is in a multimodal experience. Right.

00:13:41
But then the other thing I hear you saying is that people have sort of conjured a notion of what is legitimate and not around certain media tools. Again, maybe because YouTube has been around longer than Instagram, there's more legitimacy in the same parallel to why sitting in a lecture hall is more legitimate than listening to a podcast. Like, maybe seeing an analogy there, but. But that certainly seems to be a thing like, oh, TikTok. I mean, that's for watching, you know, things I enjoy, not like learning, but we have.

00:14:16
What if you enjoyed learning, like, maybe.

00:14:18
Then you watch it on these two things together. Joy and learning.

00:14:23
Right, right. Well, let's think about, you know, again, listeners feel free to reach out to us and say, oh, yeah, I would take a quiz at the end, or I would do something to show if you grouped a bunch of episodes together and you put something together, I would do that. We would love to hear from you because then we know that we should be spending some time, but if it's only, like, one or two, sorry, people, then we're not going to do it. But if we get a bunch of people. So if you really want that get your friends.

00:14:50
Be like, right. Chris and Rachel, reach out to them. Tell them how they are.

00:14:55
Our inbox is going to be spammed, hopefully.

00:15:00
So all of that to say that adult learning is really interesting, I don't think a lot of people use that term, adult learning. I don't think it's that much different from learning of any age. Right. But that sort of leads us into the episode today, because you talk all about adults in this interview, right?

00:15:17
Yes. I had the pleasure of interviewing Chantelle Hutchinson. Chantelle actually works with adults with acquired brain injury and is a listener of the podcast. And I, you know, at one point, Chantelle had reached out and had shared and shared that she had experience with adults. And I was like, would you love to come on the podcast to talk about it?

00:15:42
Because it's an area, Chris, that we've talked about where, you know, we don't always cover adults. And, like, you know, first of all, students who use AAC, kids who use AAC become adults who use AAC. But also there's a whole kind of other population of adults who need AAC and clinicians who are working in that world. And so I learned so much from this interview, and I'm really excited to share it with our listeners.

00:16:23
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00:16:46
We'd so very much appreciate it. Now let's get back into the episode.

00:16:59
Welcome to talking with Tech. I'm your host, Rachel Madel, joined by Chantelle Hutchinson., I'm so excited to have you here.

00:17:06
Hi. My name's Chantelle. I'm a speech pathologist working in Australia. I've been working for about 13 years with adults. So most of my experience has been in rehabilitation in both an inpatient hospital setting and community.

00:17:22
And most recently, I just started a role about seven months ago in an outpatient clinic. So that's an outpatient clinic seeing neurological clients in a multidisciplinary team, which is really nice. We see a lot of clients with acquired brain injury, like stroke, but also neurodegenerative diseases as well, like Parkinson's disease.

00:17:44
Mm hmm. Yeah, that's why I'm so excited to have you here today, Chantelle, because we don't have enough episodes and talk on the adult side of things, and it's a huge piece of AAC. And so this, this interview has been a long time coming, and I'm really excited to kind of dive in. Um, so talk a little bit more about kind of the things that you're thinking about, um, when you're thinking about AAC for kind of the populations that you're working with.

00:18:09
Yeah. So I wanted to focus a bit more on adults with acquired brain injury. And just. Just to sort of clarify, I think some people classify neurodegenerative diseases like Parkinson's disease or motor neuron disease under the Abi umbrella, but some people consider it separate. But I won't be talking so much about that population.

00:18:31
I feel like there is a bit of research out there, but I feel like there isn't a lot of research for the acquired brain injury population. And in preparing for the podcast, I obviously had a look at the research, and it was so difficult to find research, and I feel like in speech pathology, look, as a whole, we're a fairly new field, so we don't have research in a lot of areas. But I do feel like there's some big gaping holes in particular areas, and this is one of them. And I think I did find in one of the research articles that in the augmentative and alternative communication journal, only 17% of publications in the last 30 years were related to acquired communication disorders. So most of them were focused on people with developmental disabilities.

00:19:25
And then if we think about clients with traumatic brain injury or stroke, which I want to focus on today, it was a lot smaller. So it's really hard to find research out there. So I just wanted to sort of start with that, where we're trying to do the best that we can with the little information that we have.

00:19:45
Yeah, I mean, I think that it's just. It's an area that is so under researched. And also, you know, I think that that makes it hard to kind of navigate. I feel like as slps, we're used to kind of looking at the science behind different interventions, and that can help really guide our practice. And so, I'm sure, you know, for yourself and others working with adults, it's kind of like the wild, wild west.

00:20:10
Like you're. You're learning on the job, you're learning as you go. You're learning kind of by just trying different things and seeing what works. Can you speak more to kind of your own journey and how you've learned about AAC with. With not a lot of, at least science kind of guiding that.

00:20:27
Yeah, absolutely. And I guess it's been really dependent on the setting that I've been in and the other therapists that I've worked around as well. So if I think about my past roles where I worked in a hospital setting and mostly working with adults with acquired brain injuries like stroke or traumatic brain injury, I would say that on the whole, I felt like there was less confidence from adult therapists about AAC in that space, as opposed to when I went to work in the community. And a lot of therapists had a mixed caseload working with adults with developmental disability as well as acquired conditions. I think because there's a little bit more research, there's a bit more comfort sort of, in that space.

00:21:17
And that's when I learnt more about different sort of devices and apps. One thing that was quite helpful, I suppose, in my knowledge, is we do have some specialist AAC services. So there's an occupational therapist or a speech pathologist that specialized in AAC, and you can book consultations with them and you attend the appointment with the client, usually their next of kin, and they'll go through and talk about different devices that are available, different software. You actually get to see them and have a little bit of a play around with them. So going to those appointments, that was really helpful.

00:21:59
For my own knowledge, it was a lot of learning on the job. So after you'd have a consultation, then you might choose something to trial for a period of time. And it was often us learning along with the client because there's so many different devices available and technology is changing all of the time, it's really hard to keep up if you don't work in the space. So a lot of hands on learning that way through the trials and sort of supporting the client and maybe taking things home yourself first and trying to familiarize and have a bit of a play with it. Another place that I learned a lot was actually from your podcast, Rachel.

00:22:44
I think I. I discovered it during. During the pandemic. So I was living in Melbourne at the time, and Melbourne was known for having one of the worst lockdown periods during the pandemic. I think our longest one was four and a half months.

00:23:04
So I was listening to a lot of podcasts during that time and I just had a baby as well, so I was at home. And yes, this was one of the podcasts that I discovered in. And even though it wasn't geared towards adults, I just learned a lot about AAC in general, and with the job I went back to after that, there are a couple of speech pathologists there who had a special interest in AAC, and so they did a lot of internal presentations to the team, and I could go to them with specific questions, which was really, really helpful because sometimes you have very specific questions that you can't necessarily find yourself online in terms of the answers. So that's how I've learned about AAC.

00:23:51
Yeah, I mean, I did.

00:23:52
I answered your question.

00:23:53
Yeah, no, that was great. I can relate to the questions that you have that you can't find on the Internet because we're so used to in 2024 being able to just, like, Google and do a web search, and now we're using AI, like chat, GPT, and find specific answers. But there are definitely some things that are not available online. And it just, like, it really kind of showcases the need to have some type of mentor or community. So it sounds like you kind of built that with other practitioners who were interested in AAC and learning about it, which I think is a huge.

00:24:36
It's a really great way to learn and support one another because we talk about all the time in the podcast. You can feel like you're in your own silo where you're the only one at a facility or organization or a school district where you know about AAC, and it's like, okay, but what if. I don't know, right? Like, you're the one that's kind of tasked with helping everyone else learn, but there's things that you don't know. And so it sounds like, you know, you were able to kind of build out that community a little bit.

00:25:06
And I'm so happy to hear that our podcast was helpful in you learning more about AAC, even though it was, you know, we do talk a lot on this podcast, primarily about pediatrics, but I'm happy to hear that there's some universal truths about AAC that kind of, it doesn't matter what population you're working with, it's really important to kind of think through some of these lenses.

00:25:26
Yeah, absolutely. And I feel like it's very easy as a therapist to feel overwhelmed in this space and feel like you really just don't know enough. So, yeah, it is really important to have colleagues and mentors, I think. And one of the things that we did in my last, my last role that was really helpful is that we would pick a particular device or software to focus on, and we were lucky enough that we all had iPads with a whole bunch of apps on there, and we got a chance to actually have hands on practice, because I think it's one thing to learn about what's out there, but you don't really retain that information, or it's harder to apply it. When you don't get the chance to practice it or use it with a client, that information just tends to go, totally.

00:26:13
I completely agree. It's like, I'm such a hands on learner, too, that I'm like, give me it. Like, I need to poke around with it. I need to, like, play with it, um, not just hear the theory behind it. Right?

00:26:22
Yeah.

00:26:23
So let's dive a little bit into kind of the specific population that you're. You're working with. Um, I want to know kind of some things to think about because, you know, there are some people out here, uh, who are listening, who are working with adults. Um, maybe they're working with some pediatrics and adults. Um, also, I feel like we've all probably at some point or another, had an experience where, um, a friend of a friend has a loved one who had a stroke, or, you know, there's some type of point of contact with someone who has, uh, either an acquired brain injury or a traumatic brain injury.

00:26:58
And, you know, it's kind of like, I always fall back on, like, yes, I'm an SLP. Like, I can at least give you some basic stuff. Of course, when it comes to AAC, I can do a little bit more than that. But even just thinking through the lens of, like, you know, feeding and swallowing and what to think about. I just had this conversation the other day.

00:27:15
It was at, like, a cocktail party, and someone was talking about how their friend's mom, you know, had, um, was in the hospital, and I was like, oh, like, is she working with an SLP? And then I started talking about how important oral hygiene was. I'm like, we don't want her to aspirate and get pneumonia. So, can you just kind of speak to some of the things that you're thinking about when you're thinking about that population?

00:27:39
Yeah, absolutely. So I think there's a few things that tend to be unique for this population, and I might just rattle off a few of the general ones and then maybe go into specifics about how that will affect the process. I think the first big factor that is quite unique to the Abi population, especially traumatic brain injury, is their cognitive profile. So quite often, there's a lot of domains that are affected in relation to cognition that really have an impact on AAC uptake and use. So I'll talk about that.

00:28:18
I think another thing that comes along with Abi is the grief and loss that occurs after the brain injury and someone's finding their identity again, that can have an impact, and also things like their living and housing situation as well. Quite often they are moving between places and their communication partners might not be so stable. And also just thinking about the goals of this population as well is. It's not if we're talking about in the chronic phase of recovery, which is where I work, it's not about relearning language, and actually, their language might be okay, but it's really about supporting them to live well in their community, to be participating in their community, making connections. And so goals tend to be quite individual and specific.

00:29:13
So that's a bit of an overview, but I might go into each of those in a little bit more detail.

00:29:19
Yeah, let's dive in. I'm excited.

00:29:21
Okay, great. So I guess the first one, which I find the most complicated, is the cognitive profile of someone with a traumatic brain injury. And cognition can also be affected if someone's had a stroke, but it can also be affected in other neurodegenerative conditions as well. So things like someone's insight, for example, that is commonly affected in traumatic brain injury. So somebody doesn't necessarily have the awareness that anything is wrong or they're communicating differently, or maybe that their communication partner isn't understanding their message and that can have a real impact on the uptake of it and their level of motivation, because they might think, well, why do I need a communication device?

00:30:16
I can communicate just fine. So I guess that's probably one thing that can really impact on, I guess, the buy in of using AAC and then being able to potentially see the value in that. Pop, did you want to say something?

00:30:35
I was just going to say, you know, I. It's a good point as far as, like, we need motivation to do AAC because AAC is like, kind of this extra step, and it can be kind of hard for people to learn. And so, you know, when you are noticing that someone maybe doesn't have the awareness that there are communication breakdowns happening, like, what types of things are you, you know, sharing with them? Like, how do you address one of your patients who, like, not really understanding where the breakdowns are happening?

00:31:11
Yeah, so not really a straightforward answer, because I guess there's two ways you can go about it. One way is to try and build their awareness, and one is not trying to build their awareness that there is some research out there that does say that increased awareness can be linked to depression in this population because as someone becomes more aware that they're having difficulty, obviously, coming to terms with that and dealing with that versus someone who doesn't quite have that awareness, but they're not necessarily really deeply affected by it. So I guess it's very person specific as to whether or not you decide, okay, am I going to try and help them to build that awareness by perhaps demonstrating or pointing out there's been a communication breakdown and showing how we might use a device in that situation to repair it? So, yeah, I guess there's no easy answer, but therapists just need to be aware that if they are going to target awareness, there is that risk of potentially affecting someone's mental health or mood in a negative way.

00:32:27
Yeah, it's a really good point because it's kind of like, what are the ignorance is bliss. Not totally fully understanding at some level could preserve someone's mental health. And that feels like one of the hardest things about this population is really helping to support that emotional peace. I'm sure that's a really hard transition for people to have to figure out who they are after something like this happens and how their life has dramatically shifted. So it's a good point to be wary and cautious about when you are going to kind of point that out, because it is really highlighting a difference with individuals.

00:33:14
People used to understand me fine, and now nobody understands me, and I need to use a device that's a kind of hard pill, I think, probably for people to swallow.

00:33:22
Yep. And I still struggle with this one as well. I have a client at the moment who has a diagnosis of aphasia, which is an acquired language impairment. But this client, she's able to communicate verbally, generally quite well. Her main issue is word finding difficulties, and we started practicing the use of drawing to help support her message.

00:33:50
So if she couldn't quite think of the word, then a lot of the time she would draw what she was thinking, and that would help her communication partner. But the tricky thing is that she wasn't necessarily always aware when she was having difficulty in the moment. And so I, you know, at the stage where I was needing to prompt her or cue her to use that. But at the same time, she's also one of the most positive people I've ever met, and she feels that, you know, her communication, she's going really well, and she is in a general sense. And so I'm, you know, battling at the moment whether or not I persist with getting her to use this strategy.

00:34:32
And I keep drawing her attention to when she has difficulties, when she feels quite good about her communication. And so it's really just me trying to figure out and balance, is it worth it or not for this particular client, because, you know, her verbal expression is not severely impaired. So maybe for this particular client, I wouldn't necessarily persist and go down that path, whereas for another client who was really struggling to get their message out, maybe it might be worth persisting with that.

00:35:03
Yeah, it's a really good point, which is there's a lot of kind of weighing the impact. Right. Of what you're doing and how that's really affecting a person and knowing that most of the time, she's understood and it's okay versus okay. This person's having communication breakdowns left and right. Like, it feels like, you know, that is dramatically impacting their ability to communicate and therefore connect, get their needs met, and, you know, connect with others.

00:35:37
So, yeah, that's so interesting. And I'm really, my little brain who works with pediatrics is like, hmm. Like, how does this impact pediatric populations? So this conversation is, like, really, really interesting to me. And I think one of the things that I was just thinking about as you were sharing that was, you know, we have to be really careful when we're highlighting communication breakdowns for any individual, whether that's a child or an adult, because that is ultimately a negative experience oftentimes.

00:36:09
Right. It's like you tried to do something, you didn't do it in a way that was understood. People can have a very negative experience, and, you know, ultimately, you know, we want to empower individuals that we're working with to feel confident about their communication. And we know that kind of getting the AAC in place can be that. That powerful way for them to be understood.

00:36:35
But it's navigating those waters of highlighting those communication breakdowns where we have to be really careful to not be so negative, because I think even with children, they can start to feel really, they can lose their speaking confidence and then just kind of shut down and not want to communicate. And so I'm sure you experienced that in your work, too, where it's like, okay, like, they don't feel good now. They don't feel good about communication because they're aware of the breakdowns, and that can be kind of really detrimental, too.

00:37:11
Absolutely. Yep. And I guess, you know, we can think about alternative means that might also be effective, but it's not so directly and explicitly targeting it like we would in a sort of one to one therapeutic situation, because there's a lot of research on group based interventions for the TBI population. And so, you know, what you might find is when they're communicating with their peers, with their friends, they're sort of getting those natural consequences of a communication breakdown when someone doesn't understand them, and then they need to try to repair that themselves. So that might be a bit more of a sort of gentle and natural way to increase their awareness.

00:37:53
Yes, I love that because it's just a organic way to showcase, like, you're not being understood right now. And I didn't have to point it out, but you're experiencing that in real time. And I do think that kind of works towards motivation for communicating with AAC because it is, you know, universally understood, and it can be a really great way to repair those communication breakdowns.

00:38:18
Yep. Yep. Another thing that can often be affected as well in acquired brain injury is initiation. So, you know, I've had clients who really struggled with initiation, and it's not just about communication. Quite often it will affect multiple areas.

00:38:39
So, for example, I've had a client in the past who wouldn't do things like wasn't able to go to the toilet or eat, even if they were hungry, unless they were prompted or queued to do so. And so this can obviously affect the use of AAC because a lot of the time, you know, our goal on clients, clients goal. Our goal for them is we want them to be able to be independent with using the device and not need to rely or be dependent on someone else, but that requires them to initiate using the device themselves. And I think if I think about one of my clients that I had for a few years, he had a stroke, he had aphasia, but he also had cognitive impairment as well. And initiation was one of the problems for him.

00:39:34
And so we had a goal that he would be able to independently use his device, and his device was he had a smartphone, and he had an app on there called Touch Chat HD. And one of the goals we were working towards was him being able to order a coffee when he goes to the cafe and, you know, initiate doing that. And we did lots of practice of this, and I went to the cafe with him and lots of repeated practice to try and get him to that stage. And he never really got to the stage of being able to initiate that himself. And we worked on it for a few years, as well as other goals as well.

00:40:19
But I think what I realized, I think I got a little bit caught up in the need for him to initiate it, that was the most important thing for him to do. And I think just sometimes we need to sort of keep in mind what, what is the bigger goal here? And I think for him, he actually just wanted to get out of the house. He wanted to drink his coffee, and he loved socializing, so he wanted to just see people and try to have a conversation. And so whether or not he was the one to initiate pulling out the device or pressing it, it wasn't the most important thing because the staff knew him and they knew his coffee order, and so he didn't need to go through that.

00:41:03
So I think that's just one thing to keep in mind with initiation as well, is just sort of taking into account your client's cognitive profile, and if that is a feasible goal for them as well, because it can be really tricky. They might never be able to get there and they might need other things in place in order to sort of start that process of using the device in the first place and making a request or starting a conversation.

00:41:28
I love that because it kind of speaks to the importance of zooming out, which I feel like we can sometimes get super granular in our work, and we can be like, oh, we're going to target this skill and that skill. And what you're explaining is, after some time, targeting this goal, getting to know him and seeing his interactions and probably having some conversations with him, you realize, oh, this is actually the thing that matters. I feel like that's such a huge part of what we do. I'm, you know, when I'm working with kids, I'm really speaking with families about, like, what are your goals? Let's keep circling back to, like, what the family, what the family's goals are and how I can help support the family.

00:42:19
Can you speak a little bit to the process of kind of zooming out and, like, figuring out what. What to target? Like, how do you go through that process with your, your patients? Like, how do you figure out this is actually the important thing? And obviously, there's an element of time.

00:42:37
Right. It's like, as I get to know someone, I start realizing, oh, this is what really drives them. They're socially motivated. But can you speak to that a little bit? Like, how do you get really clear on the thing that's going to make a big impact in an individual's life?

00:42:54
Yep. And I think you kind of hit the nail on the head when you said that it's about getting to know your clients for this particular population. And I think probably for any client, to be honest, but building that relationship and that rapport with your client and really getting to know them as a person, I think that's when you're going to be able to help identify what goals they're wanting to work towards. Because goal setting is tricky. Goal setting is tricky for clients.

00:43:29
I think goal setting is tricky for us. I think we forget it's an extremely high level skill, and I think we expect our clients to come to us with goals, which I don't think we should expect that, especially because a speech pathologist. We're seeing clients with cognitive and communication impairments. The skill is hard enough as it is without that over the top. So actually being able to articulate that is really tricky.

00:43:54
So I found that just giving yourself permission to spend that time getting to know your client, and I know it feels uncomfortable for a lot of therapists, because I think the way we were taught, we just get in there and we have to do an assessment. We have to do an outcome measure and something that's measurable, that's just not the most important thing at the end of the day. And I found that with my client I was referring to earlier about the one who were working towards him, ordering a coffee. I had the pleasure of knowing him for about five years I worked with him, and it did take me some time to feel like I knew who this person was because he was only able to say about five words. That's it.

00:44:42
He had a severe expressive aphasia and apraxia of speech, and he had a lot of difficulty navigating even an AAC system because of that language impairment and cognitive impairment. And so he was heavily reliant on the communication partner to ask all the right questions. So he was able to answer as best as possible. And just through me taking the time to get to know him, I learned that at his core, he was very social person. He just wanted to talk to people, even though he couldn't form the words, he just wanted to hear from people.

00:45:19
You could see it in his face. He wanted to be independent. So he was a man in his fifties, and he was living at home with his elderly parents, and he wanted to move out. He didn't want to be there at the time. When I saw him the second time around, he was never leaving the house independently, and he wanted to.

00:45:41
And so we had an OT come in and just do an assessment on his road safety because he had a mobility scooter. And actually he was fine. So there was no reason that he couldn't leave the house, go down to the cafe, come back home. And that thing that seems very small made a huge impact to his quality of life, because before that, I think it'd be about three years he'd just been at home and wasn't able to leave. So it's just, there isn't a sort of magic and greedy, and it really is just getting to know your client and trying to ask all the right questions if they're really having trouble articulating goals themselves.

00:46:20
And I think for this particular client as well, another goal had popped up around. He wanted to get back to gardening. And the way that we discovered that is that we used talking mats. I'm not sure if you've heard of talking mats before. So it's essentially, there's a velcro mat, and it comes with all these different pictures, and it's intended to help with communication, so someone can express themselves by using the pitches and putting them in different columns.

00:46:51
I like this. I don't like this. And it was just through using some of those pictures and giving him options that we discovered that gardening was one of the things that he wanted to do, because he would have had no other way to be able to say that. So that's another tool that I've used before, and you don't need to have the actual talking mats, but it's just a matter of maybe showing a whole bunch of options or going through a list of things just to try and narrow down who is this person? What are your interests?

00:47:17
What's important to you?

00:47:19
I love that. I do a lot of that with the work that I do with kids. Just figuring out, sorting things I like versus the things I don't like. Like, it gives you a lot of insight. And, you know, you're working alongside of families, too, to get some insight there, because sometimes, you know, kids don't have the.

00:47:37
The skill yet of knowing what sorting is and what this looks like. But eventually, over time, they start understanding, and it's just, like, a good way to start, like you said, truly understanding. Like, who is this individual sitting in front of me? Um, what are they motivated by? What are they, what do they like?

00:47:55
And what are they not like? And I feel like you can kind of keep refining from there, but it's really important to, like, fully understand the person.

00:48:03
Yeah, absolutely. Yep. Something else that was quite interesting that I came across when I was doing a little bit of research was there was a. There was some research that talked about how the semantic organization for people who have had an acquired brain injury and I think it was particularly for people with a traumatic brain injury. So the study found that, or they described a lot of the people with a traumatic brain injury as having idiosyncratic or inconsistent patterns of semantic organization.

00:48:44
And I have just a specific example, just so it's clear to everyone what I'm referring to. But they mentioned that, for example, there were lots of people who made navigation errors when they were using dynamic AAC because the categorization system that they had didn't actually match those in the AAC system. So, for example, there were some people who considered cat to be a subordinate category of house because that's where a cat lives. And so they didn't look for cat in the category of animals, which is where most of us would go to find that particular word. And so you can imagine, and I've seen lots of clients with Abi have a lot of difficulty finding the word they're looking for within these layers.

00:49:40
And I guess, you know, reading that made sense to me because I've definitely seen that in practice a lot. And I guess you can imagine how difficult that would make it in choosing the right AAC system for these particular clients.

00:49:54
Yeah, I feel like, especially the systems that are set up categorically based, I feel the same thing when I'm working, particularly with autistic students. I feel like it doesn't, it doesn't always make sense the way that we kind of have these general categories in the AAC system set up, which just, again, makes it increasingly difficult to be able to find the vocabulary that you're looking for. Is there any, like, strategy or workaround you have for that? I mean, obviously every system is different. So kind of considering that when you are figuring out a system, is there anything else that you found to be useful?

00:50:36
Well, there is a bit of research on visual scene displays, and I have used that a few times with clients. So having the picture there and being able to have phrases and words attached to the relevant or corresponding places was in the picture, that makes more sense for some of these clients. And I found that sometimes just changing how they're categorized based on your particular client and I suppose their routine and what they're doing as well, what's going to make the most sense for them. So for clients who have a lot of difficulty with navigating and difficulty with learning and memory and all of that, sometimes you do do need to play around with the system and just make it highly individualized for that particular person. So, yeah, those are a couple of things that I would normally do in that situation?

00:51:35
Yeah, I feel like that makes a lot of sense. It's kind of like we'll start with the template and then if we need to customize based off of what we're seeing in our therapy and whether or not they're making progress towards being able to successfully and, you know, more independently navigate, that makes a lot of sense.

00:51:55
Yep. And trying to use real pictures as well. So I think, again, there's research that people with aphasia and traumatic brain injury, they will be able to learn easier, recognise pictures quicker if they are real pitches versus symbol based pitches. And it's not just real pitches that's key as well. It's personally relevant real pitches.

00:52:19
So I think they gave an example of, let's say you used a picture of a dog. It wasn't as helpful as if it was a picture of that person's own dog. So not just any dog, but that person's dog. So that can be time consuming, taking lots of pictures of everything, but really helpful for our clients. So we need to consider that as.

00:52:41
Well and really motivating. Like, I love looking at my dog. Not just a dog, my dog. I feel like that's kind of another thing about those personally relevant pictures. I am always using those types of things in therapy because it's like we want to give individuals the communication tools to talk about the things that are in their life that they love.

00:53:05
And so, like, we should kind of start off with those goals. Um, and that type of, you know, activity or materials, it's like, you know, I think it's easy to kind of just, like, pull something out of a box that, like, is supposed to target whatever, you know, goal that you're working. But if we take the extra step and time to get those pictures from the family and program those things and really using those personally relevant materials, it's just our clients are more engaged and we're actually helping them communicate about the things that matter to them.

00:53:45
Yeah, absolutely. Yep. So I guess just the other thing, just maybe the last point on just the sort of cognitive side of how things might be different is cognitive flexibility as well. And I think this is where there's been a bit of research to show that this may be the one thing that actually has the biggest impact on somebody's ability with an ABI to use AAC successfully. So I think there's a couple of definitions of cognitive flexibility, but one of them is just the ability to appropriately adjust your behavior according to a changing environment.

00:54:16
Or it refers to the ability to switch between thinking about two different concepts or to think about multiple concepts simultaneously. So I guess this really comes into play when using AAC and especially dynamic displays in being able to retain that message that they want to say in their mind while searching for it. They may need to go into different categories. They need to inhibit anything that might be distracting them. And so if this is something that is quite impaired in someone with an acquired brain injury, then you just need to take that into consideration when picking AAC and monitoring, I suppose, how they're going with it and if it's going to be even successful for them.

00:55:00
Yeah, that makes sense. I'm thinking about, like, the assessment process that you have to kind of go through with an adult. I mean, I think that that process can be tricky no matter what population, but there's so many considerations. It's like, you know, what are, what other literacy skills, like executive functioning, like you mentioned, like working memory, like, all of those things are so important to kind of fully understand as you're choosing and selecting a system. And it's just if you kind of zoom out and think about all the skills that it takes to use AAC, it becomes like, wow, like, there's so many moving pieces here, like motor skills and, you know, cognition, executive functioning, language, literacy, you know, like, all of those things.

00:55:51
It's just like, there's a lot to kind of, like, think about when you're going through the assessment phase.

00:55:57
Yeah, absolutely. And the other thing that can be quite unique to brain injury is the, this grief and loss that happens. This is obviously a major traumatic event that's happened in someone's life. And there is a bit of research out there on how, you know, self identity following a brain injury. And I like to think about this as well in, you know, the assessment and ongoing process because I always try to work out this person's routine and what they were doing before the brain injury versus what they're doing now.

00:56:31
And that can be a really helpful tool in terms of narrowing down some goals as well. But like I mentioned before, it can also affect the uptake of AAC as well, because a lot of people who have an acquired brain injury don't see themselves as having a disability. And so they don't necessarily want this communication device. They don't see that as part of, of their identity. And so sometimes it can be, you know, some time before someone's ready to use a device.

00:57:06
Yeah, I mean, that makes a lot of sense. I was going to ask the question around kind of getting clients to buy in because it feels like there's so many kind of things stacked against you. One like you just mentioned, it's like, I don't need that. Why would I need that? Like, it's understanding that new identity.

00:57:23
Who needs something like that? Feels like kind of a big pill for people to swallow, you know, that definitely makes sense. And then also, I'm sure you're working with kind of a population of both clients and families that might be overwhelmed by technology. So I feel like kind of the whole, like, okay, like, now start using this device. It's like, that feels like a lot for anyone, but especially if they've had some type of, you know, acquired or traumatic brain injury, that feels like extra challenging.

00:57:59
Just like the understanding of how to use this high tech device.

00:58:06
Yeah, absolutely. And this is where you need to take into consideration the ages as well. So thinking about TBI, I think there's three sort of age groups where TBI occurs most frequently. Under falls is one. I obviously don't work with the pediatric population.

00:58:22
Over 75 is another age group as well. And that typically happens from falls. But then there's another age group, which is around about 16 to 24, 25, and quite frequently. The main cause of a TBI is a motor vehicle accident for that population. And I guess one way to try and get buy in for that group is just trying to use a mainstream device, because chances are they had a smartphone, and there are so many apps available now.

00:58:51
And so I have found that a lot of my clients in that age group have been much more open to AAC when it's been presented on a mainstream device, rather than a, you know, big old speech generating device.

00:59:05
Right. It's not as slick.

00:59:08
Yes.

00:59:08
Big, big, clunky devices.

00:59:11
Yep. And I had a client, a young client, he was in his early twenties, and he had a traumatic brain injury. And he was quite. He wasn't really on board with using AAC, even using his phone. And because of his severe aphasia, he had aphasia as well.

00:59:27
It was quite difficult to figure out why, but eventually he was able to communicate that it was too slow for him. Because if we think about speaking, it happens quickly, and timing is important in regards to the social part of communication. If someone takes too long to respond, we think that something's wrong or we feel like we need to fill the silence. And he was a quick communicator, even though what he said wasn't always easily understood. But he still preferred that rather than how long it took to use his phone.

00:59:58
And he also felt that other people weren't patient. They didn't wait for him to try and get his message across.

01:00:05
I feel like that's kind of a universal experience for anyone who's using AAC is like, it's like people don't wait. People don't give me enough time to formulate and they're kind of speaking over me then or feeling that silence or moving on, you know, and I definitely hear that from a lot of clients, but also adults who use AAC. That's just one of the, you know, realities. Um, so I totally understand the, I'm a fast paced person too, so I can relate to this client of yours. I'm like, yes, let's, let's go fast.

01:00:36
And unfortunately, there's, there's, you can only go so fast when you're kind of generating a message on an AAC device.

01:00:44
Yep, yep. And the other thing that I just mentioned earlier as well was just something else to take into consideration for this population is that their living situation may not be as stable as maybe a child who's living at home with their parents. And that's the way that it's going to be for a while. So maybe these clients have come from living by themselves and they go into hospital, but then they get moved around in hospital. So they start off on an acute ward and then they go into a rehab ward, and now they need to go back into the community, but they're not able to live by themselves anymore.

01:01:20
Perhaps they go into shared accommodation, and then you've got all these different staff coming in and casual staff and changing communities. Communication partners. And we know how important communication partners are. And, you know, it's also really important to obviously program information that's personally relevant to the client. And when this is changing all the time, that's just an added layer that can be really tricky to manage in this population.

01:01:47
Yeah, I mean, that is a huge piece of AAC is having communication partners who understand how to be supportive. And like you mentioned, you know, adding new words and phrases and all of the things into the AAC system becomes so important as you're continuing to kind of help support an individual using AAC. And things come up all the time. And so not having communication partners who are consistent becomes really tricky. And, you know, are there any things, any things that you've kind of learned throughout your years of experience that can help support in situations like that?

01:02:31
So I guess one of the things that I try to do is I try to do group staff training. So, you know, if the client is in a shared accommodation and there's different support staff coming in to support them. I will try to organize a group training session and have everyone there, and I also try to encourage them to record that because I know that staff change all the time, so at least that's something they can use when they have new staff that come in. But I try to be as hands on as possible, and I try to go in there and demonstrate things in person, and I think just trying to keep in contact as much as possible with that network around the person and providing them with that training and education, I feel like that's probably just a key thing that we can do because we can't really change the situation for them in terms of where they need to live and who's going to be supporting them. So just trying to focus on supporting those people as best as you can and, yeah, recording it so that they have access to that as needed.

01:03:39
I love the recording piece. I'm a big believer in recording these team meetings and also asynchronous learning. It's so hard to kind of be able to interfere, interface with new team members. And, you know, oftentimes these types of principles and trainings need to happen more than once to kind of solidify for people. And so recording that and having it available to teams in a way where people understand where to get information, you know, I generally think most people want to be supportive and to help, but they just don't know how.

01:04:16
And so I feel like we can kind of alleviate some of that pressure by providing some asynchronous learning opportunities and recordings for people who won't be able to make the meeting. I think that those are really great things that we can do now in 2024 with technology that can be really, really helpful for people.

01:04:37
Yep. And including them as much as possible in the process. So not just coming up with your own sort of presentation and going there and, you know, being expert, because I always feel really uncomfortable with that when I get asked to come in and teach us how to communicate with this person, even though they may have known them for longer than me. So I may technically be an expert on communication because I have a degree in speech pathology, but I'm not an expert on the person. And so I think it's really important that you need to collaborate because they'll know a lot more than you in lots of different areas.

01:05:12
And to get that buy in from them as well, they need to feel included. So I always like to start with, you know, asking people what are they hoping to get out of the training, what questions do they have? And then trying to build around that and making it as interactive as possible. Because everyone's going to have little suggestions. Everyone will have their own relationship with the client, so they'll see different things and different skills.

01:05:35
So that's really important as well, I think.

01:05:38
Completely agree. I feel like making it more of a conversation. Um, I feel like oftentimes when people are like, oh, I have to do a training. Like, I have to have a PowerPoint. Like, I have to have all these things get through.

01:05:49
And, you know, while providing yourself structure for the topics that you want to kind of go over is important, I find that the best trainings with teams is, like you said, Chantelle, leading with questions about, you know, what questions they have, what's come up, like, really just facilitating great conversations in those team meetings, because that's how you're actually going to learn more about your client and you're going to be able to really help support. If it's just people kind of listening to, like, a slideshow presentation, they might not feel comfortable to, like, raise their hand and ask a question or recommend something or they have an idea. And so I think, like you said, really supporting that engagement and interaction and conversation is really helpful.

01:06:40
Yeah, absolutely. And you need to know where these people are at as well and their level of knowledge because you want to pitch it at the right level as well, so they might know more than what you thought or less. So it's important for you to be of that.

01:06:53
Yes. I love it. Chantelle, thank you so much. This has been such a great conversation. I'm really excited to share this with our audience.

01:07:01
And there's so many parallels, I feel like, actually, with the work that you're doing doing with adults and the work that, you know, I'm doing with pediatrics. And I just think this conversation has been really insightful in kind of thinking through some of these big picture things with AAC and really understanding how to support our clients best, which I think, again, it traverses all different populations. Right. So thank you so much for coming on. For people who want to be in touch or contact you, where's the best place to find you?

01:07:34
Well, I'm on Instagram, and my handle isphagercommunity.

01:07:40
Beautiful. Yes, we will link to your Instagram account. Thank you again, Chantelle, for coming on. This was such a great conversation.

01:07:48
Thanks so much for having me. I really enjoyed it as well.

01:07:50
Rachel, for talking with tech, I'm Rachel Maddle, joined by Chantelle Hutchinson. Thank you guys so much. For listening. Talk to you next week.