Custom Tools Developed at Shepherd Center Help Patients Communicate Through COVID-19
With intubation and ventilator use more common, patients need a way to communicate.
By Adina Bradshaw, MS, CCC-SLP, ATP
Speech-Language Pathologist at Shepherd Center
Since the beginning of the COVID-19 (coronavirus) pandemic, hundreds of thousands of patients have required intubation and the use of a ventilator. These lifesaving pieces of equipment have helped thousands of patients breathe, but they will also make it very difficult to speak. Being intubated involves a tube passing between the vocal cords into the windpipe; therefore, it can make it very difficult for patients to communicate verbally.
For decades at Shepherd Center, we have been caring for patients with spinal cord and brain injury who cannot speak due to intubation, vocal cord paralysis, tracheal stenosis and other conditions. They all have this in common – the desire to communicate. A patient's inability to communicate can add extra stress to a patient who is already in crisis mode. In fact, several studies have reported that a patient's inability to communicate can cause or further exacerbate feelings of psychological and emotional distress, anxiety, panic, fear, frustration and helplessness. Looking at it another way, a patient's ability to communicate when intubated also can decrease complications stemming from a lack of communication with members of their healthcare team.
With the rate of intubation again on the rise due to COVID-19, we continue to receive several requests from healthcare providers and peers around the country asking for advice and resources on how to help hospitalized patients with limited ability to speak. Here are my suggestions for helping people with COVID-19 find their voices.
Keep it Simple – While we all love our high-tech communication tools, sometimes simpler is better. If a patient is intubated and unable to speak but can still use his or her hands, try to communicate with pen and paper. You can also use a whiteboard and dry erase markers. A Boogie Board LCD writing tablet is also a good option if you have access to one. Of course, make sure to disinfect anything you use to communicate.
Use Yes and No – Establish a sound system of “yes” and “no” based on the patient’s capabilities. This can be as simple as thumbs up for “yes” and thumbs down for “no.” Other options are to nod your head up and down for “yes” and side to side for “no” or blink once for “yes” and twice for “no.” Then, ask targeted questions to investigate what the patient may need. Always confirm that what you think the patient is saying is correct. Make a note in the patient’s record or in the patient’s room of what their “yes” and “no” system is so that other providers can use it as well. Once you establish your yes and no system, communication will become much more manageable.
Communicate with a Board – Try using a communication board. These boards can simply say “yes” or “no,” or they can include various words such as “pain,” “thirsty,” “I’m cold,” or “What is that medication?” Or you can find premade boards with hospital-focused vocabulary here. To use one, you'll want to:
- Print out and laminate the communication board.
- Establish a reliable “yes” and “no” system with the patient.
- Place the board so that it is visible to the patient.
- If the patient can point, have them point at what they’re trying to say on the board.
- If they cannot use their hands to point, point to each row in order and ask: “Is it in this row?” or say “Row 1,” “Row 2,” etc.
- Once the patient makes a row selection, point to each successive box in the row and ask, “Is it this one?” or read the text in each box.
- Be sure to modify your speed according to the individual patient’s needs.
- Disinfect the board.
Our custom communication boards have been such a tremendous resource to our patients that Tobii Dynavox, a company that develops and provides eye-tracking technology for augmentative and alternative communication (AAC), adapted them and translated them into more than 20 languages to be used all over the world.
"When the pandemic swept across the globe last year, we were deeply concerned about individuals who currently use AAC to support their voice and in addition to all those without any warning losing their ability to communicate even the simplest of request,” says Tara Rudnicki, president of the North American Market for Tobii Dynavox. “In a chaotic hospital setting, these communication boards gave and continue to give each patient the ability to participate in their own healthcare decisions in a crisis time. They also assisted healthcare workers to quickly focus on patient needs, concerns and questions in order to deliver the best care possible."
Test Technology – Dozens of mobile apps are available to help with non-verbal communication, including Vocable, which tracks head movements to facilitate communication. There are also apps that will act as a whiteboard. When there is time for training on both the patient and provider side, these apps can be invaluable. But in a time when hospitals and care providers are likely overburdened, simpler might be better. Also, keep in mind that in many healthcare facilities, Wi-Fi coverage may be spotty, which makes many apps and online tools difficult and frustrating to use. If this is the case, see above and keep it simple.
During these challenging times, I understand that there may be no time to use some of these tools. If that’s the case, I recommend simply using the whiteboard or writing the alphabet on a piece of paper.
For additional information regarding communication strategies for hospitalized patients with limited ability to speak, please visit these resources:
- ICU Communication Boards
- Tobii Dynavox Communication Boards (account required to download)
- COVID-19 Communication Board
- Partner Assisted Communication Video
- Vocable App
For more information, you can contact me at email@example.com.
Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation. In its more than four decades, Shepherd Center has grown from a six-bed rehabilitation unit to a world-renowned, 152-bed hospital that treats more than 740 inpatients, nearly 280 day program patients and more than 7,100 outpatients each year in more than 46,000 visits.