Graphic Cuing Strategies to Facilitate Memory in the Workplace

for Individuals with Cognitive Challenges and Autism Spectrum

Disorders

BJ Gallagher PhD, CCC-SLPSpeech/Language Pathologist

Assistive Technology SpecialistFriday, November 5, 2009

10:45 to 12:00 pm

Objectives: Discuss reasonable expectations of abilities for the

completion of tasks.  Discuss assistive technology and its contribution to

helping individuals maintain independence with daily activities.

Demonstrate the use of assistive technology tools in promoting independence.

  Discuss the use of graphic cueing systems to foster

memory.  Develop strategies for enhancing memory function.

Use of graphics to enhance memory

Use of Picture Communication Symbols (PCS), graphics or photos enhance conversation.

Can help with recalling names and activity sequences

Place on phones for dialing purposes

Topics boards with words and facts aid in word finding abilities in conversation

Sample Topic Board

Wallet or Photo AlbumsBiographic - “I was born on December 1,

19 in Baltimore Maryland.”Family - My husband Brent and I have one

son Brendan who lives in Littlestown, Pennsylvania.”

Daily Life – “I wake up at 7 am daily. I get dressed before I have my tea. I go shopping on Mondays with Mary. John comes on Wednesday and brings his dog, Buff.”

People I have worked withPeople who work here

Memory Book

All examples taken from:Bourgeois, M.S. (2007) Memory books and other graphic cuing systems: Practical communication and memory aids for adults with dementia. Baltimore: Health Professions Press.

Personal Information

Low Tech PCS Intervention StrategiesCreate a manual schedule using

headliner and Velcro

Personal Communicators The Personal Talker is a one message, ten second

device with an attached protective cover. It is pocket sized, has a large press-and-play button,

and an enclosure for a picture, photo or written information.

Orientation1) To a person – Use personal ID card,

Medic Alert, self recognition with photos

2) To a place – Immediate location, community, specific locations, driving instructions, acute care

3) To Time – clocks, planners, reminder cards, reality orientation boards

4) Memory Aids5) Written Instruction cards with or w/o

pictures

Place

Shopping or Driving

Activities of Daily Living

Activities Around Work or Home

Allow Choices

Cooking

Bathroom Routines

Low Tech AT StrategiesWear Name BadgesUse of photo albums with names

attached.Label cabinets with photos of

contents.Create bins with photos.Create Step by Step photo

instructions.

Low Tech AT Strategies

Create Social Stories using PCS and Photos

Create PowerPoint with sequence of the activity to be completed

Picture Activity Schedule Boards

First/Then token board. To/Done token board. Sequence/Reward token board. Today's Schedule. Schedule. Weekly Chores.

Activity Action PlanDevelop a routine and  stick to it. 

Advance planning can help reduce the risk of forgetting.

Create a place for everything and store everything in its place.

Get OrganizedUtilize a Tote Bag or back pack. Plan

ahead place things in the tote bag of Back pack that you will need for the day's activities.

Low Tech AT Strategies for Task Completion

Use talking calculators

Auditory-Visual Timers

High Tech Solutions

Remember to requestAn Augmentative

Communication Assessment for oral communication and picture based items

and anAssistive Technology Assessment

for computer based or other items for memory, access, or writing.

General ConsiderationsThings to think about…

Hand Under Hand Technique of Assistance

It may be helpful to put your hand under the hands of persons when guiding them in a task.

You may need to remind them how to do something at first and then let them go on their own.

Let them do as much as they can do on their own.

Tips for effective communication

Body language and communication

Your facial expression, your body language, the tone of your voice become extra important when talking and communicating to someone with neurological problems.

Environmental awareness aids communication

Is the lighting sufficient to aid communication?

In conversation, we usually look at the face and body of the person talking to us. It helps us to understand content and intent. Make sure you have some light on your face.

AT Intervention:Full spectrum lighting

Speak slowly, calmly and distinctly.

For effective communication you need to balance distinctive speech without treating them as a child, without shouting or becoming angry with them if they do not understand.

Shouting also affects the tone of your voice and makes understanding more difficult.

Do not get angry even if you find yourself becoming frustrated.

It really does not help their self respect and confidence.

Give visual cues and write things down

Envelope Guide

Signature Guide

Writing Guide

Use short, familiar words and simple sentences that clearly express what you want to say. Use Picture Communication Symbols or photos to support your ideas.

Say it with symbols

Easy-to-use visual supports make communication possible for older adults who experience speech loss due to cognitive limitations, dementia, Alzheimer's disease, stroke and other illness.

Visual supports with pictures and symbols help elderly adults communicate their wants and needs to family members, nursing home staff and medical professionals.

Use the low tech and low cost communication aids and software below to make daily schedules, choice boards and more to help individuals actively participate throughout their day and minimize non-compliance.

http://www.mayerjohnson.com

Does the person have hearing or sight difficulties?

Do they need any Assistive Technologies either low tech or high tech?

Make allowances for visual and hearing deficits.

Look into getting a medical evaluation and aids to assist communication.

AT Aids for being on time!Vibrating Alarm Clock

Talking Alarm Clock

Taking MedicationPill Box with Alarm

Vision Aids

Vision AidsBar magnifiers

AT for eating

Communication RightsAll people with a disability of any extent or

severity have a basic right to affect, through communication, the conditions of their existence.

All people have the following specific communication rights in their daily interactions.

These rights are summarized from the Communication Bill of Rights put forth in 1992 by the National Joint Committee for the Communication Needs of Persons with Severe Disabilities.

Each person has the right to…request desired objects, actions,

events and people refuse undesired objects,

actions, or events express personal preferences

and feelings be offered choices and

alternatives reject offered choices

Each person has the right to…request and receive another person's attention

and interaction ask for and receive information about changes

in routine and environment receive intervention to improve communication

skills receive a response to any communication,

whether or not the responder can fulfill the request

have access to AAC (augmentative and alternative communication) and other AT (assistive technology) services and devices at all times

Each person has the right to…have AAC and other AT devices that

function properly at all times be in environments that promote one's

communication as a full partner with other people, including peers

be spoken to with respect and courtesy be spoken to directly and not be spoken

for or talked about in the third person while present

have clear, meaningful and culturally and linguistically appropriate communications

Taken from…From the National Joint

Committee for the Communicative Needs of Persons with Severe Disabilities. (1992). Guidelines for meeting the communication needs of persons with severe disabilities. Asha, 34(Suppl. 7), 2-3.

Thank you for listening

My contact information:

Dr BJ Gallagher20294 Garrett Highway Suite 1Oakland, MD 21550301-387-5580