Skydive of communication interaction (summary)


Background Outcome measures are an important aspect of evidence-based practice, the bringing together of research evidence, clinical experience and client input to determine the best course of action for an individual in the therapy setting. Outcome measures can be the result of the goals that have been agreed by a client and therapist, and they can show the progress that a client makes throughout therapy and over a longer-term period of development. A number of researchers have suggested factors that are important to the achievement of successful outcomes, including social relationships, community involvement, personal autonomy, positive self-belief and psychological safety.

What was the aim of the study? The authors of this paper wanted to present a metaphor that can represent the situation of goal setting and outcome measures in the context of aided communication. Metaphors can be a powerful tool for representing complex situations, and the authors chose to use the metaphor of skydiving to represent aided communication because many different elements must work together for a successful outcome. A skydive consists of a skydiver, a target destination and a parachute, which includes a canvas, ripcord and ropes.

What did the authors do? The authors analysed interview data that they previously collected in connection with other projects. Thirty-eight adults in Ireland and the UK aged 18-45 years were interviewed about their experience of aided communication. They all had a diagnosis of cerebral palsy with complex communication needs, and they all had been using aided communication for more than ten years. The skydiving metaphor arose out of discussion between the authors about their data.

What did they find? The findings were presented in relation to the metaphor of skydiving.

The parachute represented the technology of aided communication. Both the canvases used in skydiving and the devices used in aided communication can obscure the visibility of their users, are offered in a wide variety of options, are costly and must be adapted as users' skills change over time.

Many of the adults in the research had a clear idea of what they expected from their devices, whether it was technical features and requirements such as Internet connectivity or a long battery life, or functions that related to the personality of the user, such as a certain voice. Limitations to devices were described in terms of position, such as not being able to use a device in bed or while lying down, context, such as not being able to use a device in certain lighting or weather conditions, and technical, such as the frequency of devices breaking down.

The ropes that connect a skydiver and the canvas of the parachute represented the strategies and competence of an aided communicator. The effectiveness of the ropes arises from their system working together, just as the success of communicators depends on the range of skills they possess. Skydiver's ropes and a communicator's skills impact the success of the activity.

Interview participants reflected on their own skills and competencies, commenting that juggling all the aspects of a communication exchange is not easy. Such competencies were operational, such as knowledge of how to troubleshoot or programme devices, linguistic, such as reading, and social, such as managing conversations in stressful situations.

The skydiver is a unique individual with a certain set of resources and experiences, just like individual aided communicators. Both types of people may experience injury, age-related changes and fluctuating desire to engage in their activities. The ripcord represented the motivation and resilience of AAC users. Both skydivers and aided communicators have to decide when to deploy their technology and how to use it in the most effective way.

Many research participants indicated their persistence and resilience in using AAC and identified contexts where they took control over their use of a device. Some individuals commented that aided communication is 'very very hard but keep going' and that 'it opens a world of communication'. Another learned to programme a Pathfinder. The decision to use a device was governed by the health and energy level of the user, the activity and location of the interaction and the communication partner.

The jump of a skydive represented the journey of aided communication. The initial stage of the jump is determined to a large extent by external forces but only occurred because of the decision of the skydiver. Though each jump follows a predictable course of action, each jump is also varied and distinctive. This is like the combination of aided and unaided communication strategies. After choosing to use aided communication, an AAC user combines different strategies and different types of communication, and each journey in an opportunity to practice new skills. Landing at the destination of a sky dive represented the personal life goals of an aided communicator. Even though a skydiver may not land exactly where he intended, the landing allows the skydiver to share in a community of other skydivers and can be the start of another new and exciting part of their journey.

Interview participants mentioned many aspects related to the ongoing use of aided communication and desired outcomes of continued practice. They made gains in education, inclusion and independence and had goals related to employment and leisure.

In addition to these elements, a skydiver can only jump independently after appropriate apprenticeship and learning opportunities. Other factors, such as weather conditions, will continue to influence whether a skydiver wishes to participate in the activity on every occasion.

Interview participants also made reference to their learning experience and factors that affected their decision to use an aided communication device. Learning was affected by practice and an individual's support system and advocates. Barriers to the use of a communication device included the skills and attitudes of communication partners, lack of time and noisy environments.

Conclusions: In this paper, the activity of skydiving was used as a metaphor for the use of aided communication. Participants in both activities have individual needs and aspirations that change across time. In particular, the outcome measures used to evaluate aided communication can and should relate to the attainment of specific goals in relation to a certain longer-term destination. In skydiving and aided communication, the development of proficiency is marked by ongoing accomplishments, and each occasion of participation in the activity is the result of an autonomous choice, requires the intersection of a range of skills and is subject to a variety of external factors.

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Added to site January 2014