If you need further information on methods of facilitated communication training, a simple outline is given in

Crossley, R., 1994, Facilitated Communication Training, Teachers College Press, New York, $15.95

The Introduction is given below. The Contents page and Chapter Two of the book are also available on-line. We are very grateful to Teachers College Press for permission to republish this material on the Web. Ordering details are given at the end of the extract.

1. Introduction

Facilitated communication training is a strategy for teaching individuals with severe communication impairments to use communication aids with their hands. In facilitated communication training a communication partner (facilitator) helps the communication aid user overcome physical problems and develop functional movement patterns. The immediate aim in facilitated communication training is to allow the aid user to make choices and to communicate in a way that has been impossible previously. Practice using a communication aid such as a picture board, speech synthesizer, or keyboard in a functional manner is encouraged, to increase the user’s physical skills and self-confidence and reduce dependency. As the student’s skills and confidence increase the amount of facilitation is reduced. The ultimate goal is for students to be able to use the communication aid(s) of their choice independently.

Facilitated communication training is a teaching strategy of particular relevance to individuals with severe speech impairments who can walk but have had difficulty acquiring handwriting and manual signing skills. Many such people are diagnosed as intellectually impaired and/or autistic. Through facilitated communication training numbers of these people have achieved functional communication, often revealing unexpected understanding and academic potential.

Background

My initial use of facilitated communication had no theoretical basis. It was a measure forced upon me by circumstances. After teaching children with cerebral palsy for five years, in 1977 I started to try and devise a means of communication for a socially responsive sixteen year-old with athetoid cerebral palsy and no intelligible speech, who had been labelled profoundly intellectually impaired.

Anne had been living in a state institution since she was three, and was still the size of a three-year old. She had no wheelchair and lay on the floor during the day. Severe extensor spasm had caused her body to arch in a bow shape, with her head pushed backwards towards her heels. When she was seated in a baby buggy (a larger version of a baby’s stroller, and the only seating available) her head and shoulders retracted to the extent that she was at risk of suffocation. In order for her to look at anything placed in front of her it was necessary to flex her hips forcibly and bring her head forward. In order for her to point it was necessary to use my hand to internally rotate her arm and raise it from its retracted position behind her. With this support Anne pointed correctly to named objects, pictures and a few Blissymbols before going on to learn to read and spell.

Anne left the institution at the age of eighteen, still in the baby buggy, after instructing a lawyer and winning an action for Habeas Corpus in the Supreme Court of Victoria. Now in her senior year at university, Anne still uses facilitated communication. For her it is a matter of choice:

I communicate by spelling on an alphabet board, on which I can reach a top speed of 400 words an hour. ... I own a Canon Communicator ... which I use with a headpointer ...; a speech synthesizer ... and a computer which ... is the slowest to use of all my high-tech communication equipment. ... I can type at ten words an hour, provided someone else sets up the computer. ... The gadgets enable me to do things I can't do without them, but they don't let me do them fast enough to make it worthwhile. If technology made me normal, it would be great; as it is it makes me slower and less efficient and reduces the time I would otherwise spend with non-disabled people. (Harrington,, K. A letter from Annie, Communicating Together, 1988)

In Anne’s case facilitation produced only minimal physical improvement. For her, independence could only come through alternate means of access, a headpointer or switches, which she found unsatisfactory. There will always be some people who can only communicate with facilitation or who have to choose between restricted or slow independent communication aid use, and dependent, faster, more fluent communication.

While Anne’s use of facilitated communication caused considerable local controversy in the seventies ,Anne was certainly not the first individual with such disabilities to have shown academic abilities and therapists experienced in working with people with cerebral palsy were not surprised that a child with severe cerebral palsy and no speech could have been mis-assessed and could have considerable untapped potential. The use of facilitated communication training with individuals with other diagnoses, however, still arouses controversy . Since the sixties facilitated communication has been used occasionally with people with autism — Rosalind Oppenheim, in particular, articulated a rationale and a program for teaching children with autism to communicate through facilitated handwriting in her book Effective teaching methods for autistic children, which was first published in 1974. — Until recently, however, it has been applied to only a few individuals.

The development of a training program based on facilitated communication was stimulated by the opening of DEAL, Australia’s first centre devoted solely to the needs of individuals with severe communication impairments not caused by deafness, in 1986. It was expected that the clientele would be largely people with cerebral palsy or acquired brain damage. In fact, from 1986-90, only 213 (32%) of DEAL’s 666 clients with developmental disabilities were diagnosed as having a severe physical impairment and 636 (95 % )were labelled as either intellectually impaired or autistic or both. Statistics on the incidence of severe communication impairments are limited but it appears that (a) a high proportion of those individuals labelled as severely or profoundly intellectually impaired have severe communication impairments, and (b) the majority of those with severe communication impairments are labelled as intellectually impaired (often in association with other diagnoses such as cerebral palsy or autism). In a statewide survey of all individuals with developmental or acquired severe communication impairments, 71% of all respondents had been labelled as intellectually impaired (Bloomberg & Johnson.,1990)

Of the DEAL clients labelled as intellectually impaired or autistic two-thirds were reported as having some exposure to manual signing programs but only 4 had acquired more than 100 signs. Of those aged over 10 fewer than 5% could write a simple sentence to dictation, and fewer than 50% could write their names.

During assessment of selection skills some 90% of the 452 individuals labelled as intellectually impaired who did not have cerebral palsy showed neuro-motor problems which adversely affected their ability to make accurate selections from a communication display. The most common were eye/hand co-ordination impairments, impulsiveness, perseveration, low muscle tone and inability to isolate an index finger. Facilitation was used when necessary to provide temporary remedies for these problems while academic skills were assessed.

The results of academic assessment were initially surprising — some 70 % of the 431 aged over 5 showed useful literacy skills, defined as the ability to type a comprehensible sentence without a model. On reflection our surprise diminished. Unlike Anne, most of these people were living in the community and had attended schools; they could all walk and pick up books and magazines, and had considerable exposure to ambient print on television, signs, packaging etc. Their speech and hand function impairments, however, had prevented them from using any literacy skills they had acquired. Initially all but two of those with previously unused spelling skills required facilitation in order to use keyboards successfully.

The occupational and physical therapists at DEAL suggested strategies that could be used to improve specific hand functions, and the combination of facilitated communication and motor training was called facilitated communication training. Not all users of facilitation have literacy skills; facilitation is used when necessary to assist individuals accessing symbol and picture boards, or choosing from real objects, such as toys.

Facilitated communication training is far from problem-free. The most obvious concerns are the need for facilitation, the dependency that this may produce, and the risk of facilitators unduly influencing communication. Essentially facilitated communication training is an ad hoc solution to some of the communication problems of ambulant school-age children or adults with both severe speech and hand function impairments whose communication cannot be put on hold while they undertake a lengthy occupational therapy program.. While some hundreds of individuals have been assisted by facilitated communication training, it is not an ideal strategy — it is the strategy you use when you don’t have a better one.

Facilitated communication training has excited attention because the communication produced with facilitation is unexpected in both style and content, and challenges previous assumptions about the language skills of specific groups, especially people with autism . The most important contribution facilitated communication training could make to the field of non-speech communication would be to bring about the re-evaluation of individuals with severe communication impairments who are labelled as intellectually impaired, and a re-examination of the methods used to assess individuals with severe communication impairments. Detailed neuro-motor assessment of all infants with significant speech delays and early intervention by speech/language pathologists and physical therapists could eradicate the need for facilitated communication training in a generation. In the meantime the findings which led to facilitated communication training should add further impetus to research into the neurological links between speech and hand function.

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