Relying on assistants
Other people often guide Anna’s use of language. She can restrain impulses only for a short time. She adapts her behaviour a bit with others and tries to calm herself rather than allowing others to comfort her. Anna does not express her feelings verbally; instead, she relies on assistants to understand and fulfil her wishes and needs, accepting their decisions.
Anna can wait a while for things she enjoys and relies on the assistant’s suggestions and guidance in how things should be done. Anna has a sense of time and needs many repetitions to the daily routine, especially if there are changes to the plan.
Limited sign language
Anna communicates by visual sign language – but not at an age-appropriate level. She uses from one to up to eight signs, depending on the situation, and she likes to use reference objects such as pictures, books, and games.
One of her communication strategies involves asking questions using one to two characters, while simultaneously expressing a questioning attitude. The person she’s communicating with needs to figure out what Anna is asking and try to get more details to understand.
Once Anna is motivated and has received information, she can participate in a conversation.
”Once Anna is motivated and has received information, she can participate in a conversation.”
In-depth knowledge
Anna likes to hand over messages from one assistant to another, ensuring that everyone is informed. She can start a conversation with one word and then look at the assistants with the expectation that they know what she is thinking.
The assistants use triparty conversations to support her, limiting the sign space, supporting the signs tactilely, and using clear body language.
Anna understands more signs than she uses. She is a “data collector” and wants information about fellow residents and staff regarding absence, illnesses, holidays, and shift schedules.
The communication topics Anna selects are often very personalised, person- and context-dependent, which requires an in-depth knowledge of her.
Pictures for communication
Numbers are a favourite: how many different things they had for dinner, how many buns were baked, how many presents she got for her birthday, etcetera. She also takes notes of time, such as when someone needs to go home or when she is going for a walk.
Anna expresses wishes for her social pedagogical schedule for the day and if making purchases, what to buy. She films her everyday experiences on the Ipad and takes pictures. Afterwards, she enlarges them to study them closer.
Interaction with Anna – a video analysis
We have included a video analysis here to give an example of Annas communication methods. In the video, Anna and an assistant are sitting at a table with a calendar in front of them. Anna grabs the assistant's right wrist and points with her other hand to another assistant who is sitting at the same table knitting. They both laugh before the conversation begins.
Anna: (Name) – holiday home.
Assistant: You say (name) and holiday home, what do you think?
Anna: (Pointing to her diary) Search – holiday – home – date – search.
The two assistants communicate verbally about the dates.
Anna lightly places her hand on the assistant’s wrist to establish contact, subsequently pulling the assistant’s arm towards herself. She tries to turn the assistant’s head while maintaining hand contact.
Anna: (Changing subject pointing to her tracheal cannula and then to her calendar) Summer house – go again.
Assistant: We should also look at when to go to the hospital.
Anna: Summer house.
Assistant: On 30 March we can look at the summer house.
Anna: (Pointing at the assistant and then down at the table) Is (name) present?
Assistant: (not answering the question).
Analysis
The video shows several topics of conversation at the same time. From Anna’s perspective, they are talking about holidays, the coming visit to the hospital, and who is coming and when.
The assistants also discuss the organisation of staff holidays. They should have discussed this before the conversation with Anna because she gets confused, and Anna and the assistant talk past each other.
Initially, Anna does not realise that they are talking about a colleague’s holiday and not her own. A couple of times, Anna tries to return to and point to the calendar to confirm that they are talking about her holiday, while the assistant is still talking about when a colleague might be going on holiday.
A future action strategy must be for staff to coordinate dates for hospital visits, staff holidays, and possibly the exact date of the Annas holiday before involving her.
Better sign language knowledge
Another strategy is higher partner competence. The partners must be at a higher level of sign language than Anna so that they can challenge and refine her sign language level at the right times and with empathy. Enhancing Anna’s ability to express herself in a more nuanced way will provide her with greater opportunities to influence her own life.
In the conversation, she is the one who points out that at the time of a possible holiday trip, there is also time scheduled for a hospital visit. Anna shows a great and long-term overview of time and a good memory. The video sequence also shows that Anna can focus on more than one topic at a time, as she brings several topics into play unprompted and on her initiative.
Support, but avoid confusion
Anna often mixes various topics into a single conversation, and the partner needs to help maintain focus and structure preventing unnecessary confusion for Anna. The ability to include related topics in the main conversation is a cognitive skill that should be supported and developed. However, it is equally important for the partner to assist Anna in avoiding having too many different topics in one conversation, to prevent misunderstandings.
It might be tempting to conclude that the confusion is caused by the assistant in the video. This occurs when the assistant, without informing Anna, shifts the topic and starts to talk about the colleague’s holiday while Anna is still talking about her own holiday.
When developing future strategies for Anna, it is important to consider the assistant’s role in the conversation and Anna’s overview and energy levels.