Getting your message across ... creative idea to support communication across the ABI rehabilitation process

My aim for this post is to share a creative practice idea that I have been developing, which involves producing video summaries to assimilate, synthesise and explain complex, case-related information to the people I work with.  Most of these people have cognitive communication difficulties (CCD).  Producing videos might sound complicated but having explored the features available on keynote (other slide show software available), I have found that a video is just one click further on from a slide presentation, so if you can use keynote, slides or Powerpoint, you are more than half way there!  For me, this has been a game changer, providing a simple and effective method of communicating between a team and the client and also addressing some of the communication challenges that my clients face through their rehabilitation.    Below, I will explain what lead to me to use video, the benefits for my clients and myself, as well as tips on how to make your own videos with ease!  
  
As is often the way, I started experimenting with technology to solve a practical issue.  During the pandemic, I was working entirely virtually, as well as homeschooling.  My circumstances necessitated super efficient and speedy planning but I did not want to compromise on the quality of my therapy materials or independent practice.  One day, I wanted to present a simple therapy task on ‘Zoom’ and rather than using the whiteboard to scrawl some ideas, I made a very simple slide show on keynote.   At the end of the session, I emailed the slide show to the client for practice and received positive feedback about how helpful this had been.   This was the catalyst for my thinking about how to use keynote to share other types of information. 

I had always used time-saving templates to write guidelines or independent practice but discovered that having understood how to use the features of  keynote; slides are far quicker.   I have also discovered that you can convert a slide show into a video at the click of a button (see image below) so with very little effort you can produce a narrated video, which you make as simple or complicated as you like.  I think clients like this because the narration makes the information less formal.  I can explain context and concepts more succinctly when narrating the slides.  There are also multiple, creative ways to reinforce the message, which I will explain below.  As Confucius said (or it might have been Napoleon or Fred R. Barnard, there is some debate!) “ A picture is worth a thousand words”.   I will explain the process below but first let’s consider the value and rationale for providing videos for clients with CCD. 

The Challenge
I have had more than one conversation with a client in which I discover that even though the topic has been discussed at length amongst the team and also with the client themselves, it is clear that the client does not fully understand the plan.  They might be expressing feelings of disengagement, frustration, even a loss of trust in the team and rehabilitation process.  Reflecting on conversations like this has made me think more deeply about the client’s experience of communication with a rehabilitation team.  Proceeding through any rehabilitation process presents a challenge for anyone experiencing CCD.  It is increasingly clear to me that there is an essential role for a speech and language therapist (SLT) to analyse communication competence across the rehabilitation experience and to identify support needs.  This will be look different for each client but addressing these needs throughout the process is essential for all.  Let’s breakdown just a few potential areas of difficulty!

Essentially, at the heart of any multidisciplinary case conference the client and the team are having a conversation.  This conversation will have a number of different functions, i.e. request feedback from the client thereby challenging their narrative skills, or make plans for future goals which might involve verbal reasoning and decision making skills.  There are likely to be multiple people in the room (I would guess a minimum five) and the to and fro between this group is likely to be challenging for any client with CCD.  All this before thinking about different communication styles or terminology that a client might need to interpret to make sense of each contribution to the discussion.  Then what about the effect of impaired memory or fatigue?

Or, how about working towards an interdisciplinary goal with the contribution of two or more team members.  Even if the team collaborate with the client to plan and goal set, we are asking a lot for the client to recall the detail, join the dots beyond and between the planning and therapy sessions or to appreciate how the session with one team member links in with a session delivered by another team member.  

The reality is that in a medico-legal case there are multiple processes going on simultaneously and it can be very difficult for the client to understand the nuance and complexity of these processes.  

A creative solution
A video summary is proving to be one of my go-to tools for alleviating these challenges and examples of complex ideas I have explained using video include: 

• the plan for vestibular rehabilitation package involving four professionals and several different types of session that were not obviously linked
• explaining how a client will receive their money, to which accounts and what support will be given for managing their budget
• exploring why impaired verbal reasoning makes certain real life decisions difficult so that I could collaborate with the client to develop support strategies to share with the team

The process 
Throughout the case, I:

• keep my ears open for any particular areas of complexity or misunderstanding happening in the case; colleagues who have worked with me for a while will now raise topics to be summarised
• work with the relevant colleagues to gather information about the message to communicate, either through email or by meeting face to face
• assimilate all the available information and synthesise this into key messages for the client
• present that information in a keynote including pictures, audio, sometimes video embedded within the slide.  Sometimes I animate the slide but this is where it starts to add time to the process, possibly unnecessarily. 
• Simple single word or phrase information might include:

                    > a summary of a goal
                    > rationale for working towards the goal or making a particular decision and how the work    
                    relates to the client’s values
                    > text or photo of the team members with a simple outline of their particular role in the goal
                    or decision
                    > images to represent concepts relevant to the topic, i.e. I added an image of lightbulbs to
                    illustrate the concept of generating ideas on a slide about verbal reasoning
                    > information about what is going to happen and when, timelines etc.  
                    > flowcharts (arrows, appearing/disappearing text boxes) with animation to illustrate  
                    changes to a plan

• send this keynote in draft form to the team to make sure that I am accurately reporting the message
• make any edits or updates 
• convert the keynote to a movie (there is method for doing this on keynote in one click so I assume this will be the same with other software, see below) and circulate to the client and team via WeTransfer.  The videos I have made are usually only 2-5 minutes long but they are too large to send without a tool such as WeTransfer

Other ways to use video have been: 

• information for the clients about communication support strategies
• training for family 
• the therapy team can/I have:
• start(ed) session(s) by watching the video to set the scene for therapy and prompt memory
•  used the film to develop outcomes and refine goals with clients 
• Often I have updated the videos at different stages in the intervention to chart progress, which can be a nice way to communicate outcomes to clients .

The feedback
So far, I’ve had positive feedback from team colleague, clients and family alike.  Here is some of the feedback that has been shared with me:  

• one client could read with difficulty owing to vestibular difficulties so benefitted from a video with simple written information and an audio narration to explain changes to his care plan
• another client wanted to work on a social goal but was inhibited by vestibular impairment, which meant that he did not want to be in busy environments

​​step one was to improve vestibular skills so he would gain confidence to spend more time in busy environments but this was not an obvious first step for the client

recommendations for vestibular rehabilitation involved focused physical activities and the client couldn’t engage with these activities until we used a video to explain the link back to his social goal

as soon as he saw the video, he said, “OK, I get it!” and has not only been engaged in physical therapy to improve vestibular skills since then but has also been more involved in goal setting and planning

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So, I conclude with an encouragement to speech therapists out there to consider their role in supporting communication throughout the rehabilitation process.  This post suggests one creative idea but I am sure there are plenty more ideas out there.  Some colleagues have asked me to share these ideas outside of my teams and provide some training so that this idea can be replicated with other people experiencing CCD and I am more than happy to do that, on request.  Feel free to ask for more details if you find this blog helpful and I am happy to give a more practical demonstration of this idea in a future blog.