Communication Needs & ICF Model

Communication and ICF

• Identify atypical communication needs
• Select communication needs for patients with hearing/visual impairments
• Select communication needs for patients with different languages, aphasia, apraxia, cognitive issues, motor impairments, or who are intubated
• Perform tests considering individual communication needs
• Educate patients on physical therapy assessment using strategies and devices

The ICF Model

• Health Condition (disorder/disease) affects Body Function & Structure (Impairment)
• Health Condition affects Activities (Limitation) and Participation (Restriction)
• Environmental and Personal Factors can affect all components

Body Structure & Function

• Impairments are physiological/anatomical issues affecting communication
• Hearing impairments involve issues with auditory system
• Speech impairments involve problems with vocal cords or oral structures
• Neurological impairments refers to conditions affecting brain functions like aphasia/apraxia

Activities

• Communication activities consist of two main types:
• Expressive Communication: Conveys messages via speech/writing/gestures
• Receptive Communication: Understanding messages conveyed by others

Participation and Social Contexts

• Social Interactions: Engaging in conversations/socializing/community activities
• Daily Activities: Communicating effectively in daily tasks such as ordering food or using transportation

Environmental Factors

• Facilitators and Barriers are external factors supporting or hindering communication
• Facilitators: Assistive devices (hearing aids/AAC), social networks and accessible public services
• Barriers: Physical obstacles, social attitudes and lack of communication support

Personal Factors

• Individual Characteristics: Personal attributes impacting communication
• Age and Gender refers to age-related hearing loss or gender-specific communication styles
• Education and Literacy refers to level of education affecting used language/understanding
• Coping Styles and Motivation refers to personal strategies for communication challenges

Conclusion of ICF

• Understanding communication in the context of the ICF model allows for identification of needs and selection of communication strategies

Atypical Communcation

• Communication impairments/conditions can include hearing/visual impairments, language differences, aphasia, apraxia, cognitive issues, motor impairments and intubation

Hearing Impaired

• Causes: Congenital/age-related hearing loss, noise exposure, infections or trauma
• Communication Needs: Lip reading, sign language, writing and assistive devices
• Strategies: Use visuals/written materials, face-to-face, speak clearly, use interpreters and technology

Visually Impaired

• Causes: Congenital blindness, age-related macular degeneration, glaucoma, diabetic retinopathy or trauma
• Communication Needs: Verbal descriptions, tactile feedback, Braille and large print
• Strategies: Use verbal descriptions/tactile cues, organize the environment, provide info in the format needed

Intercultural Communication

Different Languages

• Causes: Speaking different cultural languages with limited proficiency in the area's dominant language
• Communication Needs: Interpreters, translations, simple language and visuals
• Strategies: Use professional interpreters, provide materials in preferred language/simple language and visuals

Aphasia

• Causes: Stroke, brain injuries/tumors or neurodegenerative diseases
• Communication Needs: Simplified language, visuals, gestures and boards
• Strategies: Simplify, use gestures/body language and AAC devices (allow extra time to answer)

Apraxia

• Causes: Brain damage impacting motor planning, due to stroke/head injury
• Communication Needs: Consistent cues, breaking tasks into steps and use of AAC
• Strategies: Visual/verbal cues, break task into steps, one step at a time and repetition

Cognitive Barriers

• Causes: Dementia, disabilities, brain injuries, psychiatric conditions or palsy
• Communication Needs: Simplified instructions, repetition, visuals, structured environments
• Strategies: Simplify instructions, repetition, reinforcement, schedules and routines

Motor Impairments

• Causes: Cerebral palsy, spinal cord injuries, dystrophy or neuromuscular conditions
• Communication Needs: Adapted tools, boards, AAC devices and gestures
• Strategies: Writing tools, communication boards, electronic aids and non-verbal techniques

Phonating Ability

• Causes: Intubation, tracheostomy, vocal cord damage or other medical conditions affecting voice
• Communication Needs: Writing tools, boards, text-to-speech devices and signals
• Strategies: Writing tools, communication boards, gestures and signs

Educating Patients

• Use analogies and avoid jargon, use visuals, repeat key points, check understanding, be patient/compassionate and explain to caregivers

Conclusion of Aytpical Communication

• Understanding and addressing communication requires adaptability, patience and use of appropriate tools
• Can significantly enhance relationships/treatment outcomes in physical therapy,
• it is essential for effective, inclusive and patient-centered care

Aspects of Culture

-"The common world of meanings" of a group or collective, which consists of language, knowledge/views, values/standards and symbols/rituals

Communication Related to Age

Language

• Ask how to pronounce their name correctly/how they want to be addressed
• Provide qualified language interpreters
• Check the understanding of explanations
• use visuals and use multilingual materials
• Avoid using Jargon

Knowledge, Views, and Images

• Do not assume your knowledge and views concerning patient care are shared by your patient
• Shared-decision making is much less common for some than others
• Recognize different views of gender

Values and Standards

• Don't impose your own values and norms
• If you have doubts about certain standards, ask
• Observe non-verbal behavior
• Don't force eye contact and always ask for permission before touching

Symbols, Rituals and Heroes

• Non-verbal expressions vary among cultures
• Used caution with hand/arm gestures

Summary of Intercultural Communication

• Remember the person is always an individual
• Intercultural communication is interpersonal communication that requires adjustments & modifications

Communication with Children

• Communicate with a child, depends on level of: cognitive, social and emotional development
• there is a scale from complete dependence to independence and autonomy

Age vs Ability to participate in Healthcare

• Two years old can indicates their needs and participate in discussions of health, but can not understand how their actions can affect their health
• At 6, they can begin understand diseases and treatment decisions
• Eight years old can understand concrete examples but not hypothetical situations, and they are capable of a reasonable degree of self-management
• Twelve can understand illness, how it occurs, how they can control it and can receive a message at same level as an adult

Younger Children

• Communication transitions from non-verbal to verbal
• They have a fear of strange environments
• Use of pretend play can be beneficial
• Rules and fairness

Strategies To Use With Children

• Non-verbal communication is important
• Use Open-Ended or multiple choice
• Use Directive Questions
• Use an Inquiring and Interested attitude
• Avoid intonation that can indicate that something’s right or wrong
• Provide visuals
• Use Age Appropriate Games, images or Metaphors

Role of Parents and Caregivers

• Parents and caregivers play a crucial role in a childs healthcare
• In order to have successful outcomes it is important to have Involvement and Understanding
• Make sure the parents/caregivers that are involved are Well-Informed and is made sure that they are Empowered to Make Decisions regarding their Child's healthcare
• It is important to Bridge the communication gap between a child and the health provider

Strategies with Teenagers

• Primarily Focus on the Teen and secondarily the Parents
• Involve them as much as possible in discussions
• Play the role of Confidant
• Use Open-ended Questions
• Use Directive Questions

Considerations As Aging Occurs

• Cognitive Functions Decline
• Cognitive tasks become more difficult
• There is Memory Loss
• A loss of learning Ability
• Difficulties in Spatial orientation
• There is less ability to think analytically
• Language functions
• There are issues with Processing of information
• Implementing of new Routines, is difficult
• To gain insight into connections Between certain things

Strategies with Older Adults

• Do not use Condescending or Derogatory Language or Tone
• Moderate Your Pace
• Summarize, in writing, when necessary
• Limit to One Topic per Sentence
• Use Directive Questions to encourage further discussion on specific topics

Key Factors

_ It is important to remember that Families and Caregivers are very important parts of the equation _ Try to Define the Companion’s Role in the appointment _ It is important, especially with older patients, to make sure they know they are responsible for making their own Choices _ you should always Direct Your Remarks and Questions to the Individual