TOTAL COMMUNICATION

work as a curriculum leader and a teacher of communication in a large further education college. The learners on my course all have cognitive difficulties, either from birth or acquired later in life. In 2005 a group of us - teachers, learning facilitators, families and carers - agreed we would run a small scale curriculum action research project to clarify the benefits of using Somerset Total Communication with our two groups of learners. We wanted to know if: both groups could be taught in the same way individuals in both groups could learn to use Somerset Total Communication tools there was a measurable increase in self-confidence all would show an interest. In class we use the communication tools of Somerset Total Communication, mainly with the learners with congenital difficulties. Somerset Total Communication is a multi-agency partnership led and jointly funded by Somerset County Council and Somerset Health Community to ensure a consistent cradle to grave strategy (www.somerset.gov.uk/somerset/socialservices/pi/stc/, accessed 2 November 2006). At our college we have a service level agreement with Somerset Total Communication which allows us to access support from the speech and language therapist who works there and the network of Somerset Total Communication co-ordinators. This partnership provides a service that includes lifelong support for people with communication challenges, a library of resources that can be used to support communication for this client group, and training for those working with them. All our learners respond well to the resources - objects of reference, pictures and symbols to support the spoken word - and we use them in class. Our research project was to be submitted for my Masters dissertation (Prince, 2006). My personal journey to this point began when I volunteered to work with a child with a brain injury in the early 1980s. This set me on a path that led me to work in clinics designing home programmes for families and people with brain injury. I then set up and provided a massage and aromatherapy service to people with both congenital and acquired difficulties before moving from this into support and education. To fulfil these roles I have studied ITEC (The International Examination Board) massage, anatomy / physiology, and aromatherapy, British Sign Language to level 2, Somerset Total Communication and Deaf Blind communication skills. I have a Certificate in Education and a Masters in Special Education which later included consideration of speech and language difficulties. I have also studied Damaged Brains and Neural Nets with the Open University.

Shifting perceptions
Photo by Mark Palmer (www.allaboutcapture.co.uk)

Perceived relevance
Prior to starting the research I liaised with the Somerset Total Communication speech and language therapist and the speech and language therapist at the local hospital. This was invaluable for us in starting the project as, before we carried out the work, we wished to ascertain its perceived relevance to colleagues, related professionals, clients, carers and families. We also wanted to identify specific focus points and any prior appropriate research that could inform the team. I found information relating to the positive use of Somerset Total Communication with people with congenital learning difficulties but was unable to find

Julia Tester reflects on a small scale curriculum action research project using Somerset Total Communication with two groups of learners with severe and complex needs resulting from congenital or acquired difficulties.
reports of its use with people with acquired brain injuries of the severity experienced by some of our learners. Those with the greatest challenges to learning move on a scale from being asleep - or with their eyes open and unable to communicate with intent - through to having their eyes open and being able to communicate with intent. People who seem to have low levels of awareness are not easily assessed and may appear to fluctuate in their responses. I found articles dealing with people on the minimally conscious scale of value for increasing my understanding of the issues (Laureys et al., 2000; Katz, 2001; Weil 2005). The project was in two phases. It set out to teach five signs or symbols to six people (three with congenital difficulties and three with acquired), all between their late 30s to early 50s. These symbols were person specific and chosen as a result of input from the clients and / or carers, family or learning facilitators. The aim was to establish communicative abilities for each learner and to identify any problems with methods, as well as familiarising the learners and everyone involved with the process. It was then repeated five months later to clarify the initial results and identify retained skills. To do this we observed and recorded responses to previously learned

SPEECH & LANGUAGE THERAPY IN PRACTICE Summer 2007

TOTAL COMMUNICATION

signs or symbols and gave the learners the opportunity to learn five new signs or symbols and thus develop the process further. During the project the learners were all exposed to Somerset Total Communication at college during their weekly communication session. On our programme the learners have an option to attend several short sessions per week. The choices include: Communication, Information Technology and a Craft subject. When not at college the learners are supported by carers in residential or nursing homes. During this time they have opportunities to access the community; for example, two learners with congenital difficulties attend a bread making class.

certificate for recognising three symbols. We were aware that it is possible these learners had experienced Somerset Total Communication previously in attending a day centre or in a residential home and that prior learning may have predisposed them to engage with it again. We are also aware that we had used Somerset Total Communication with them - albeit in a less focused way - so it wasnt totally new.

More standard communication

As the project progressed there was some increase in use of the tools with the learners. Some carers became more confident in using them and two achieved the induction level in Somerset Total Communication. This was a particularly exciting aspect of the project as we had hoped it would develop a more standard communication in different areas of the learners lives. The method used for our recording was participant observers. We recorded on a formal checklist any communicative response observed, including eye/hand movements, vocalisations, gestures and signs. I found it extremely exciting to see the increase in communicative behaviour between the learners and staff. On one occasion I was greeting the learners who all sat in a communication circle. Some spoke, some signed and one learner generally remained with their eyes closed. This particular morning I paused, longer than usual, to

This project taught me a great deal about...the need to give time to our learners to respond.
Two of the learners with acquired difficulties were less likely to have encountered signs and symbols prior to their disabilities and one had used them but we were not aware of duration or intensity of their involvement. All three had been exposed to Somerset Total Communication at college prior to the research but again in a less focused way. Of this group two people achieved certificates for recognising five or more symbols and one learner for recognising three symbols. Two of this group had not spoken in college and have started doing so (single words and couplets). We feel it is not possible to judge to what degree the increased attention given by learning facilitators during the project and the stimulation of using an accessible communication method contributed to this and how much was natural progression and recovery from their brain trauma (with a resulting increase in wakeful periods). However, having observed the learners increase in attention and developing confidence in using Somerset Total Communication, I personally do not doubt that the communication tools were beneficial. We found learners with congenital difficulties required a longer period of input before they showed confidence in using signs and/or symbols. We felt that this may be due to the fact that they had never developed a wide vocabulary at any point in their lives in the way that learners with acquired difficulties had. Dyer (2001) comments, what we speak and what we write and how we read form only a minuscule part of the language we use in our waking and indeed in our sleeping hours. It follows that much of language development takes place in the head. Partly this is a factor of brain maturity (p.79). As the groups require different amounts of input we feel it is more appropriate to teach the two groups separately. Due to fluctuations in attention, it wasnt easy judging whether learners showed increased interest in their sessions. However the fact that learners with acquired difficulties spent more time with their eyes open, and that all learners acquired a certificate, indicates engagement in the sessions.

ing facilitator or family member with little or no experience of this type of recording). Also on reflection I have become aware of the problem of possible inconsistency when different people complete questionnaires for a client due to staff availability and response. The project is small scale and focuses on individuals at a specific time in their lives. This makes it difficult to reproduce. However it is exciting that our learners with acquired severe and complex communication needs responded positively. On a personal level I learned a great deal from my studies, not least about how little I knew then and now, and how much there is still to learn in order to provide the best service to these amazing learners. I would hope that others may feel motivated to offer these communication tools to people with acquired brain injury, to give them further opportunity to start to communicate again. If anyone wishes to do so I would value the opportunity to liaise and SLTP support in any way possible. Julia Tester is a curriculum leader and a teacher of communication at Somerset College of Arts and Technology, email: Greystarh@yahoo.co.uk.

References
Brown, N., McLinden, M. & Porter, J. (2003) Sensory Needs, in Lacey, P. & Ouvry, C. (eds.) People with Profound and Multiple Learning Disabilities. London: David Fulton, pp.29-38. Dyer, C. (2001) Teaching Pupils with Severe and Complex Difficulties. London: Jessica Kinglsey Publishers. Katz, D. I. (2001) Minimally Conscious States [Online] Available at: www.kurzweilai.net/articles/art0161.html (Accessed: 9 March 2007). Laureys, S., Faymonville, M-E., Degueldre, C., Del Fiore, G., Damas, P., Lambermont, B., Janssens, N., Aerts, J., Franck, G., Luxen, A., Moonen, G., Lamy, M. & Maquet, P. (2000) Auditory processing in the vegetative state, Brain 123(8), pp. 1589-1601 [Online]. Available at: http://brain. oupjournals.org/cgi/content/full/123/8/1589 (Accessed 9 March 2007). Prince, J. (2006) An Evaluation of Teaching & Learning Somerset Total Communication in a Further Education College to Two Groups of Learners. One group with Acquired and the Other with Congenital Severe and Complex Needs. MEd dissertation. The University of Birmingham. Weill Cornell (2005) Giving Voice to Hidden Lives, The Weill Cornell Scope July-August [Online]. Available at: www.med.cornell.edu/publications/pdf/thescope/2005-07-08 (Accessed 9 March 2007).

I found it extremely exciting to see the increase in communicative behaviour between the learners and staff.
allow time for response. My mind was elsewhere, on the next stage of the lesson. Suddenly I heard a colleague draw in a breath and I refocused on the learner who had now opened their eyes and was moving their hand and arm up to sign good morning. They were smiling and appeared excited by their own ability to respond. I felt very emotional at this point and wondered what had triggered the learner to communicate that particular morning. Had I approached them differently? Was the temperature in the room different? Was it the extra time given? Was it that this was one of their waking times? As they had previously responded more during one-to-one time, we were very excited that they seemed happy and had responded in the group circle situation. This incident marked a shift in my perceptions. As Brown et al. (2003) said, The necessary concentration on the learner in order to encourage and extend these exchanges is also likely to make us aware that the learner has in fact a number of expressive actions of which we may have been unaware (p.33). The outcome of the project was that both groups were able to learn and use Somerset Total Communication when taught in the same way. Two learners with congenital difficulties achieved certificates for recognising five or more symbols and one learner achieved a

Resource
Information on Somerset Total Communication is at www.somerset.gov.uk/somerset/socialservices/pi/stc/.

Time to respond
This project taught me a great deal about my own receptive communication skills and about the need to give time to our learners to respond. I have also become aware of the difficulties of analysing responses to questionnaires (and of all the potential for genuine under/ over attributing of skills) and the difficulties for those filling in questionnaires (whose role may be carer, learn-

REFLECTIONS DO I PAUSE SUFFICIENTLY FOR LEARNERS TO RESPOND? DO I THINK LATERALLY WHEN SEARCHING THE LITERATURE? DO I APPRECIATE THE LIMITATIONS OF USING QUESTIONNAIRES?

SPEECH & LANGUAGE THERAPY IN PRACTICE Summer 2007