AAC and cerebral palsy

Cerebral palsy (CP) is a disability caused by damage to the brain before, during or shortly after birth.  People with CP usually have motor problems. They might have trouble walking, eating or speaking. There are different types of CP and its severity varies enormously.  Some people might just have weakness on one side of their body and slightly slurred speech, while other people with CP may be in a wheelchair and need help with everyday activities, such as eating, grooming and communicating. People with CP may also have an intellectual disability, vision problems and/or hearing problems.

Most people with CP have speech, although sometimes their speech can be difficult to understand.  AAC can help these people to communicate more effectively.  The type of AAC they use will depend on their needs and abilities.

AAC and cerebral palsy in early intervention

Early intervention can help children who have CP to develop their expressive communication skills.  Early intervention may refer to informal therapy activities carried out by the family at home, or more formal programs run by trained professionals.  Early intervention programs generally see children up to the age of six years.  They may be based at a school, a centre, or therapists may see individual children in their homes.  People involved in early intervention programs might include teachers, speech pathologists, occupational therapists psychologists, physiotherapists and other professionals.

When a child is slow to develop speech or if speech is difficult to understand, he or she might be introduced to AAC. This may be aided or unaided or a combination of both. No matter which method of communication the child is using, he or she needs to see others use it too.  A good time for developing a child’s communication skills is during play and routine activities.  The AAC system selected for each child will depend on his or her physical skills.  Communication strategies might include facial expression, body language, gesture, vocalisations and speech.  The child may be introduced to key word sign (Makaton) or the use of electronic or non-electronic communication aids.  Children at this age generally cannot read and spell.  This means that they usually use communication aids that display a combination of photographs and/or line drawings, rather than words or letters of the alphabet.

AAC and cerebral palsy at school

Most children who have CP attend mainstream schools and others attend special schools.  Children who have CP may use a range of communication strategies at school.  The communication strategies used will depend on the child’s skills and abilities.  Strategies might include speech, vocalisations, facial expressions, body language, communication displays and/or voice output communication aids.

When selecting or designing communication displays (eg. communication board, wallet, folder) and voice output communication aids, it is important to consider the child’s eyesight, literacy skills and motor skills.  Since children with CP have problems with motor skills, they can have difficulty pointing to individual items on a communication aid or device.  Items on the communication display may need to be a particular size so that the child is able to point to them.  Some children rely on indirect access to indicate items on their communication aid. This means other people may need to help by asking yes/no questions to identify the correct vocabulary item on a non-electronic communication aid.

Alternatively, the child may use a switch on a voice output communication aid to operate the device.  The vocabulary selected for the aid should allow the child to request items or activities, comment on people and events, indicate likes and dislikes and participate in social interaction. It is important to teach children who use AAC speech and language skills to help with the development of spelling and literacy.

AAC and cerebral palsy beyond school

Some adults who have CP live independently or in the family home.  Others live in shared housing or supported accommodation.  Supported accommodation facilities, such as community residential units can also provide respite care for people who normally live at home.  Some people who have CP and live at home spend time in day centres, which provide care and recreational options for people who have disabilities. Others work in supported or mainstream employment.

People who have CP can use a range of communication techniques within supported accommodation and day centres.  For example they may use speech, voice attempts, gesture, communication displays, voice output communication aids and/or key word sign.  It is important to consider the person’s literacy skills when selecting or designing communication displays (eg. communication board, wallet, folder) and voice output communication aids.  Some adults who have CP have good literacy skills and may use communication aids and devices that are based on words and/or letters of the alphabet.  Others are not literate and may use photographs and/or line drawings on their communication aids.  

In general, AAC use for people who have CP is likely to be less formal within the home.  Speech that is difficult to understand may be better understood by friends, family members and other regular communication partners. It is only when communication breakdowns occur that the person with CP may use a more formal method of communication.

The National Relay Service (NRS) provides telephone support to individuals who have complex communication needs needs and their communication partners. There are two different ways that the NRS provides help. Firstly, people with speech that is difficult to understand can speak to the operator at NRS who will interpret what is said and repeat the message to the listener. Secondly, a person with CP may use a telephone typewriter (TTY). This is a keyboard attached to a telephone, which is used by the person to type their message. The message is received by the relay officer who reads it aloud to the listener. In both situations the listener uses speech to respond.
 
Personal response systems are small personal alarms, which may be worn around the neck, on the wrist, or on a key ring.  They allow people who have complex communication needs to access help in an emergency situation.

To learn more about Cerebral Palsy visit the Cerebral Palsy Australia Learning Centre.