#DEN4001
#D4/S1/W2
#Paediatrics
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Communication strategies

Task breakdown

• activity broken down into component steps, which are individually and slowly presented
• similar to tell show do

tell show do

• break down task into steps
• tell patient what we will do
• show the patient what we will use
• then do the action

Rescuing

• second person enters situation to help the patient instead

Distraction

• singing, holding items, gentle touch, talking to distract the patient from the situation at hand
• direct attention and focus to another happening

Bridging

• patient holds same object to improve sensory connection and task focus while operator carries out an activity

hand over hand

• guide patient with your hand, good for OHI

CHaining

• operator starts activity and patient completes it

COMMUNICATION IN SND

Communication is a two way process involving the receiving and sending of information through a variety of means:

• written

• spoken

• non-verbal methods such as

  • tone of voice,
  • facial expression
  • body language
  • gesture

• people with learning disability have difficulties communication, may have difficulties understanding and using verbal methods, including:

  • hearing and visual impairment
  • difficulty focusing and sustaining attention
  • poor auditory memory
  • lengthy processing and response time, including others not allowing enough time
  • difficulty understanding the words used by other people, such as grammatical concepts and time concepts
  • limited expresdsive vocab and word finding difficulties
  • weak and/or uncoordinated oral musculature

Communication

• reason for attendance
• medical history
• explain treatment needs
• gain informed consent
• provide appropriate preventive advice
• manage unfavourable clinical events
• words
• tone of voice
• body language
• 

Lexicon of special needs

• not about the words but the context
  • who says it
  • who hears it
  • where it is said
  • when it is said
  • how it is said

• Sensory Disability
  • Hearing impairment
  • Visual impairment
  • Deaf and blind
• Neurological deficits
  • Aphasia
  • Dysarthria
• Alternative or augmentive communication

Hearing impairment

Visual impairment

• 
• guide patient into surgery
• talking to patient in the surgery
• printed material
  • letters
  • appointment cards
  • information sheets
  • postoperative instructions
  • signage in the practice

Deaf and blind

• generally partly deaf and partly blind in older population
• congenitally often linked to peri natal conditions such as rubella virus
• also congenitally associated with
  • learning difficulties
  • epilepsy
  • physical disability

Aphasia

• acquired communication impairment resulting from damage to portions of brain responsible for speech
• impairs person ability to process language
• affects all 4 modalities of language
  • reading
  • writing
  • comprehension
  • expression
• problems with expressive language, receptive language or both
• 

Dysarthria

• collective name for group of speech disorders resulting from neurogenic disturbances in muscular control and resultant paralysis, weakness or unco-ordination of speech musculature
  • articulation
  • resonance
  • cerebral palsy
  • multiple sclerosis
  • motor neurone disease
  • stroke
• best to encourage to do one thing at a time
• give time to reply
• reduce distractions/background noise
• watch person as they talk
• let speaker know when you have difficulty understanding them, don't pretend
  • repeat part of the message you understood so they don't have to repeat the whole thing

Alternative or augmentive communication

• people with disability have varied communication skills
• people with moderate to severe levels of intellectual disability often are better at understanding than producing language
• unaided systems
  • gestures (use a gesture to signify they want help etc., or using a photo book to communicate )
  • key word signs (sign language)
• aided systems
  • tech
  • nontech
    • books, boards
    • charts
    • cards
    • picture sequences
• multimodal
  • usually involves a combination of multiple methods

Paediatric Treatment Planning

Key principles of teamwork

• shared understanding of who is part of the team
• shared goals
• clear roles and responsibilities
• mutual trust and respect
• effective communication
• quality improvement: measuring processes and outcomes