Most people whose speech is severely impaired also have difficulty with handwriting.

People with SCI and hand function impairments are particularly vulnerable to having their cognitive abilities underestimated owing to the dependence of standardized intelligence tests on speech and hand skills. People with SCI who achieve effective communication aid use may reveal previously unsuspected competencies.

Many children with SCI find themselves caught in a downwards spiral: assessed as significantly intellectually impaired as a result of their speech and motor impairments, they are placed in a school where their speech and motor impairments are seen as being the unavoidable corollary of their intellectual impairments. They are unlikely to receive an occupational therapy assessment, and speech therapy is likely to be at a premium. The combined effect of continued failure (after all, the student does not have the basic output skills necessary for success), low expectations and lack of therapy is likely to be deterioration or stagnation rather than improvement. The student's behaviour is often as poor as their academic performance.

As assessment of students with severe expressive problems is so difficult, no student should be excluded from a communication training programme on the basis of previous negative assessments. Often the training is a prerequisite for accurate assessment. Always give the student the benefit of the doubt.

DEAL Communication Centre tries to enable people with communication impairment - to help them achieve their own goals and be fully participating members of society.