Disclaimer: this resource is intended for speech and language therapists and students of this profession. If you require therapy for aphasia please contact a speech and language therapist.
Total Communication
Summary: An approach which seeks to facilitate communication by any and all modalities available to the individual with aphasia. This may include supporting speech, gesture, facial expression, drawing, body language, prosody, and writing as well as word lists, communication books and more high tech augmentative and alternative communication systems. Good candidates for this approach are those individuals with aphasia who have limited or no speech, good awareness of their difficulties, and spontaneously attempt to use alternative means of communication at times (Pound et al., 2000).
Example: Total Communication encompasses a wide range of approaches to therapy and many, if not all, functional therapy approaches can be said to embody its principles, e.g. Supported Conversation for Adults with Aphasia, Promoting Aphasics’ Communicative Competence, & Conversational Coaching (see links at bottom of page). The following activities may support the introduction to and development of Total Communication with a client:
- Making clients aware of all possible communication modalities (e.g. mind maps, showing videos and encouraging clients to reflect upon the different types of communication used)
- Modelling of Total Communication approaches for clients
- Watching videos of different types of comm, client noting down
- Barrier games in which the client is encouraged to use Total Communication (as is practised in Promoting Aphasics’ Communicative Effectiveness)
- Use of Total Communication to engage in more functional tasks (e.g. expressing opinions or preferences, communicating the steps involved in an activity, roleplaying everyday interactions such as ordering food)
- Involvement and training of family members (including video work to highlight ways that family members can best support the individual’s communication)
- Group work with other clients with aphasia
- Supporting clients to create a hierarchy of everyday situations from least to most demanding and support them to implement Total Communication in these situations, progressing from least to most challenging
Evidence Base: While limited studies explicitly investigate the use of Total Communication, as noted above, many functional therapy approaches include a focus on multimodal communication (see the studies detailed in the entries on, for example, Promoting Aphasics’ Communicative Effectiveness and Supported Conversation for Adults with Aphasia).
Rautakoski (2012) used questionnaires to study the perceptions of participants with aphasia and their communication partners about their functional communication before and after a course of Total Communication (carried out over 12 days in a 3-month period). Conversation partners felt there was a significant improvement in functional communication following a course of Total Communication. Prior to the intervention the participants with aphasia rated their functional communication ability significantly higher than their conversation partners rated their abilities. This disparity disappeared during treatment. In a similar study Rautakoski (2011) found that participants with aphasia and their partners reported an increase in use of nonverbal modalities and low-tech communication aids after Total Communication treatment.
Lawson & Fawcus (2001) report a case study of an participant with severe expressive and receptive aphasia and severe articulatory dyspraxia who received Total Communication therapy. Following a programme of individual and group therapy targeting the gestures / Amer-Ind signs, drawing, and writing as means of communication, the client was noted to spontaneously use drawing, gesture and sky-writing to communicate in addition to a limited range of spoken words.
Rautakoski (2012) used questionnaires to study the perceptions of participants with aphasia and their communication partners about their functional communication before and after a course of Total Communication (carried out over 12 days in a 3-month period). Conversation partners felt there was a significant improvement in functional communication following a course of Total Communication. Prior to the intervention the participants with aphasia rated their functional communication ability significantly higher than their conversation partners rated their abilities. This disparity disappeared during treatment. In a similar study Rautakoski (2011) found that participants with aphasia and their partners reported an increase in use of nonverbal modalities and low-tech communication aids after Total Communication treatment.
Lawson & Fawcus (2001) report a case study of an participant with severe expressive and receptive aphasia and severe articulatory dyspraxia who received Total Communication therapy. Following a programme of individual and group therapy targeting the gestures / Amer-Ind signs, drawing, and writing as means of communication, the client was noted to spontaneously use drawing, gesture and sky-writing to communicate in addition to a limited range of spoken words.
References
Lawson, R. & Fawcus, M., 1999. Increasing effective communication using a total communication approach. In: Byng, S., Swinburn, K., & Pound, C. eds. The aphasia therapy file. Hove: The Psychology Press, 61-74
Pound, C., Parr, S., Lindsay, J., & Woolf, C., 2000. Beyond aphasia: Therapies for living with communication disability. Bicester: Speechmark
Rautakoski, P., 2012. Self-perceptions of functional communication during total communication intervention. Aphasiology, 26(6), 1-21
Rautakoski, P., 2011. Training total communication. Aphasiology, 25(3), 344-365
Lawson, R. & Fawcus, M., 1999. Increasing effective communication using a total communication approach. In: Byng, S., Swinburn, K., & Pound, C. eds. The aphasia therapy file. Hove: The Psychology Press, 61-74
Pound, C., Parr, S., Lindsay, J., & Woolf, C., 2000. Beyond aphasia: Therapies for living with communication disability. Bicester: Speechmark
Rautakoski, P., 2012. Self-perceptions of functional communication during total communication intervention. Aphasiology, 26(6), 1-21
Rautakoski, P., 2011. Training total communication. Aphasiology, 25(3), 344-365
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