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Aids For Communicating With Hospitalized People?

charliezcc writes "My grandmother recently fell and broke two vertebrae (among other things) and is in the hospital while she recovers. Thankfully, she was not paralyzed and retains the use of her limbs. However, they have placed her on a respirator and she is virtually unable to communicate with us, so while we try to keep her company during her recovery, our company is reduced to mainly one-sided conversations. Asking her questions, even yes/no questions, is hard because of the neck brace — it turns into a guessing game and very quickly becomes frustrating for both parties. I'm a firm believer in the power of positive mental attitudes and to make her recovery a little better and I'd like to be able to facilitate two-sided conversations with her so she can keep positive. Keeping in mind that she does not have much technology experience, what would you suggest I utilize to ease the communication barrier? I remember seeing devices with a number of buttons that say whatever you program it to say, but I can't find these anymore. What other kind of devices are available?"

32 of 160 comments (clear)

  1. A Low tech solution by janrinok · · Score: 4, Insightful

    I sympathise with your problem and wish your grandmother well. But try to get her to blink rather than nod her head. It is used quite frequently in cases such as this. I'm not trying to be rude, nor to sidetrack your question, but while you are doing your research it will enable limited 2 way conversation.

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    1. Re:A Low tech solution by maxume · · Score: 4, Funny

      Grandma, two fingers for yes, one finger for no. And so on.

      --
      Nerd rage is the funniest rage.
    2. Re:A Low tech solution by HalifaxRage · · Score: 5, Funny

      "She keeps telling me 'no', and always with the same finger"

      --
      bomb the us up set someone
  2. Can she move her hands ? by thornomad · · Score: 4, Informative

    If she can move her hands you can setup a type of "communication board" -- the simplest of these can be words written on a piece of paper/cardboard. If she is able to point to them then she can communicate in a limited way. You can have one for basic needs and another for spelling words. That is the less technological version of what some people use (and I can't remember what it is called) that let's someone touch a screen that, in turn, speaks for them. A quick search and I find stuff like this. I'm sure there is more -- better -- out there. Good luck. That isn't easy.

  3. Bed Time by Knunov · · Score: 4, Funny

    Time to go to sleep. When I read the headline I thought, "Yeesh, that's a pretty harsh punishment for commuting with hospitalized people. And why do people in the hospital need to be sharing a car, anyway?"

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    Why do users with IDs under 100,000 or over 700,000 usually have the most worthwhile comments?
  4. you could try these by EricMB20 · · Score: 4, Informative

    i've used these products in the past with children with special needs - they're great communication tools - a bit expensive - but good - you can rent them weekly as well so that might be a plus - good luck! http://www.dynavoxtech.com/

  5. eLocutor by uss_valiant · · Score: 2, Informative

    For the extreme case there's eLocutor. It was designed for Stephen Hawking who can only push a single button. But it also has a mode for users that can control arrow keys in addition to a single button.
    I don't know the field at all and I don't know eLocutor but from an article. Maybe it has a huge learning curve and is thus inappropriate as a short-term solution.

  6. Signalling yes and no by QuickFox · · Score: 2, Interesting

    She probably shouldn't nod and shake her head to signal yes and no, as that may strain her spine. Propose some other signal. The easiest of all is probably that she make the same movements with her fist that she would otherwise make with her head, imitating nod and head-shake with her fist.

    Or better, give her a chart of the Sign Language Alphabet. With that she can say anything, if she and her listener both have enough patience. With that she could sign "Y" for yes and "N" for no, and in many cases choose among alternatives with just an initial letter.

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    1. Re:Signalling yes and no by QuickFox · · Score: 2, Informative

      A better chart, a little clearer.

      --
      Terrorists can't threaten a country's freedom and democracy. Only lawmakers and voters can do that.
  7. As someone who knows.... by Anonymous Coward · · Score: 2, Insightful

    The easist solution is a whiteboard. They make them small enough to hold in one hand.

    Here's the catch though. If she's on a respirator, she's under some level of sedation. She might be pretty awake and all, but she's unlikely to remember much (if anything) while she's on the respirator. (Respirator's are not fun to the body)

  8. Old Topic, new answers by fishdan · · Score: 3, Insightful

    I used to be a Sp.Ed teacher working with severe autistics (which has really made me a great member of a dev team). I had many students who could communicate, but did not have the fine motor skills to speak. High tech is sometimes more than you need. I know you're willing to spend whatever it takes for your grandmother, but in this case, a little time investment may be wiser than a cash investment.

    My first suggestion is American Sign Language With a minimal amount of effort you can be communicating simply, and there's no reason to not spend more time learning more and stepping up to high end communication. I find ASL so useful that I've taught it to my friends for communication in loud bars, silent communication in meetings, secret messages we wish to pass in a room full of people, etc.

    In terms of full fledged speakers, since you are not looking for a permanent solution, I'd recommend just using a OSX notebook. Open up the terminal, and type 'say hello world' You get the hang of it really quickly. On the windows side, Read Please is quite competent, and has a 30 day free trial period. Plus there is probably wifi in the hospital...

    If you don't have a laptop that she can use, I would suggested printed boards. The 800 lbs gorilla in the field is Mayer-Johnson. Look around their products and see if maybe you can get away with something like their Picture Exchange Communication System. Essentially they are cards with pictures on them that can be used for communication. It's not a great system for an adult, but if you need something temporary it's only $179.

    I wish your Grandmother a speedy recovery.

    --
    Nothing great was ever achieved without enthusiasm
    1. Re:Old Topic, new answers by 0123456789 · · Score: 2, Informative
      An alternative to OS X (or, at least, an OS independent solution) for text to speech is to use Emacs.


      Seriously.


      Take a look at EmacsSpeak, which handles text to speech (as well as speech to text).


      Having said that, if nodding and shaking her head are too much; I doubt typing will be an option either. I think one of the lower tech solutions are more likely to be useful. Good luck!

  9. Re:Paper and pencil? by Anonymous Coward · · Score: 2, Funny

    >Paper and pencil?

    Listen, this is Slashdot. Stop being practical and start thinking like a wannabe nerd.

    Don't listen to him, Charliezcc! Here's what you have to do: First get a PDA - not a current one, mind you, but something old and preferably unpopular.

    Then, port Linux to it. You'll probably have to write the handwriting recognition software yourself, but no problem, right?

    Once done, it will be the ideal device to facilitate two-way conversation between you and your grandmother.

    Off you go! Shouldn't take more than a week, I'd say.

    Oh, and I wish your grandmother the best and hope that she has a speedy recovery.

  10. Read to her? by beadfulthings · · Score: 5, Insightful

    If your grandmother is stuck on her back, and it sounds like she is, she might enjoy an occasional reading session--not too lengthy, though. Check at home. Does she subscribe to any particular magazines or to the newspaper? Chances are she's missing those. Any particular authors she enjoys? Something lightweight in her favorite genre (mystery, sci-fi, thriller, classics whatever) might be enjoyable. Religious? Bible or other scripture might be wanted. Of course you can get audiobooks of all sorts, but the actual presence of somebody she loves, who cares enough to take time with her, is a good medicine in and of itself. Check with the occupational therapy folks regarding the boards they have for communicating needs/wants.

    --
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  11. Think low-tech, not high by Tsu+Dho+Nimh · · Score: 2, Insightful

    A small whiteboard and marker pen
    Pen and paper

    There's no need to go any higher-tech than that, because you would have to teach her how to use the device instead of using her existing knowledge of how to write.

  12. Low Tech by sakusha · · Score: 3, Insightful

    This problem requires a low tech solution. And fortunately, this is a problem that has a lot of practical solutions, derived from years of experience dealing with hospitalized, incapacitated patients. I used these to help take care of my mom, she was unable to talk.

    Consult your hospital, they often have little message boards. There are some that have a little flip chart at the top, divided into functional categories like "I feel.. (sleepy, nauseous, good, thirsty etc.)" I want (water, pain meds, bedpan, etc.)" and then it has an alphabet at the bottom to spell out words that aren't on the chart, along with a list of common words so she doesn't have to spell them out (it, and, the, etc.).

    If she can write, I recommend a "Magna-Doodle" pad. Very easy to use, clears with a push of the lever, designed for little kids so it's easy to use even for someone weak and incapacitated. Get a big Magna-doodle pad, that makes it easier to write long messages, or write big if you have poor motor control.

    1. Re:Low Tech by Captain+Chaos · · Score: 2, Interesting

      I second the recommendation for a Magna Doodle if she can write. We got my mother a large one after her 2nd surgery to treat cancer because she was unable to talk. It really worked out well, especially when she was weak because she could rest it on her lap or the small table attached to the bed. You can give it to kids when it is no longer needed and let them enjoy it then.

  13. Re:if she can move her hands, mouse+ screen keyboa by scottv67 · · Score: 2, Insightful

    have a TV or large monitor brought in with a mouse...

    Um...no. Don't bring a pickup truck-full of electronics into the hospital room. The nurses have enough to do without stumbling over cords from devices you brought from home. The original poster said that the patient was on a ventilator. There are probably already quite a few electronic medical devices in the patient's room. If you are thinking of bringing in something bigger than a laptop, check with the nurses on that unit first.

    Yes, I work in healthcare.

  14. Paper and pencil? by kbahey · · Score: 2, Insightful

    First, hope she gets well soon.

    Why must hi-tech be the answer?

    Why not use paper and pencil?

    Are her hands free? She can gesture yes and no in a way that you can tell her to.

  15. Really only TWO options available by spineboy · · Score: 4, Insightful

    Pencil and paper, or some type of pointing board with common phrases/questions/answers on it. Most hospitals will have both.

    As far as having his GRANDMOTHER learn any new technological choices, while in a hospital, sedated, on a ventilator, in a neck brace - FORGET IT. She's not gonna learn sign language easily, except yes/no. If she can't even write, because of medication/delirium/whatever, then she's not going to be able to learn new ways of communicating.

    Sounds like she's an old lady, and somewhat frail like many older people. Becoming intubated for a vertebrae fracture is not normal, so I think she probably has multiple medical problems (I'm a doctor).

    Stick to what she knows, and is comfortable - and she will do better with it.

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    ..........FULL STOP.
    1. Re:Really only TWO options available by networkBoy · · Score: 2, Interesting

      I realize it's likely cost prohibitive, but from what I've seen of Mr (Dr, Sir?) Hawkings kit, the UI is very intuitive, especially for the portions where you're not trying to build a sentence (or a speech for that matter). You look at what you want to say and if you either blink or hover long enough the computer says it. It'd make yes/no I hurt, etc. questions a cakewalk.

      @ spineboy
      Assuming these are *not* cheap, how much is too much (IYHO) before a hospital would not buy them to have on hand in cases like this? AFAIK they are not even available as even a specialty item, but it got me thinking...

      -nB

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    2. Re:Really only TWO options available by wing03 · · Score: 3, Informative

      "I realize it's likely cost prohibitive, but from what I've seen of Mr (Dr, Sir?) Hawkings kit, the UI is very intuitive, especially for the portions where you're not trying to build a sentence (or a speech for that matter). You look at what you want to say and if you either blink or hover long enough the computer says it. It'd make yes/no I hurt, etc. questions a cakewalk."

      It's called a Dynavox. http://www.dynavoxtech.com/

      IIRC, my wife who's in the field of speach therapy and augmentative communications, mentioned he uses a switch that measures muscle tension and a scanning keyboard/UI to pick and choose his words.

      Yes, they are expensive. They also need training to use as well as it needing training, setup and/or direction from a speach therapist to a caregiver in order to setup.

      For someone in a hospital, a communication board (8x10, 11x17 or whatever grid of organized pictures and letters) is more effective and simple. Most hospitals should have these to communicate basic needs like itchiness, pain, sensory answers a nurse of doctor would ask.

  16. LOL - that has to be the worst solution so far by spineboy · · Score: 2

    Kudos for an original idea, but do you really expect some old grandmother, sedated, on a respirator, from a minor vertebral break, to learn Morse code? For a young person, it's a better idea, although limited, because not everyone knows Morse code. With pencil and paper, she can communicate with everyone.

    --
    ..........FULL STOP.
  17. Sign language by Migraineman · · Score: 2, Interesting

    Learning morse takes a buttload of time. It's extremely abstract, and probably isn't going to be easily memorized by someone who's sedated. If she already knows morse, then I'd say it's more of an option.

    Alternatively, teach her a handful of ASL signs. "Yes" is a fist you nod. "No" is two fingers pinched against the thumb. Finger spelling resembles the written characters in many cases, so it shouldn't be a big burden to learn. Don't be afraid to invent signs - that's perfectly valid, especially when the signer has mobility issues. We've done baby-sign with both of our kids, and it's worked out wonderfully. Some suggestions:

    Pain - touch left and right index fingers together, then point to the pain
    Help - raise your hand like you need to ask a question
    Hungry - motion like you're putting food in your mouth
    Thirsty - lift the imaginary cup to your mouth
    Water - place the sign "W" to your lips
    Toilet - wave the sign "T"
    Sleep - place one or both hands against your cheek
    Done - place a hand flat over your mouth (hard to do when on a respirator, so invent one that works)
    More - touch all fingers in each hand, then tap the two finger bunches together

  18. Re:Paper and pencil? by mrbooze · · Score: 3, Informative

    The hospital I worked in something like 15+ years ago had a supply of Magna Doodles. (I think that's what they were called, basically a toy that you could write on with a magnetic "pencil" and easily wipe off anything you wrote by sliding a level.)

    They kept a few around the ICU/CCU for patients that needed them to communicate. At the time I sort of assumed that most hospitals kept some sort of tools around for that purpose.

  19. Dasher - 1 finger text entry by StCredZero · · Score: 2, Interesting

    A tablet PC with Dasher might be the thing. Dasher is designed to enable 1 finger text entry at reasonable speed. My girlfriend uses it because of her repetitive stress injury.

    http://en.wikipedia.org/wiki/Dasher

    http://video.google.com/videoplay?docid=5078334075 080674416&q=dasher+google+tech+talk&total=2&start= 0&num=10&so=0&type=search&plindex=0

    But if she can still write, that will be even better and faster.

  20. Augmentative and alternative communication by arb+phd+slp · · Score: 2, Informative

    This is exactly what I do for a living.

    Consider how long her recovery is expected to last. If she will be off the vent and speaking soon, you probably can make do with some low-tech solution or a stock laptop. A whiteboard and/or a cardboard alphabet and some immediately useful messages.

    If it is going to be a while (more than a couple weeks) insist that the speech therapist at the hospital see her. Insurance will pay for speech therapy if you go the "Communication allows for active participation in care and treatment which has been demonstrated to improve recovery time and outcomes" route. A MEDLINE search will find plenty of clinical proof of this if you need it.

    There are several manufacturers that make computers for this express purpose. Some have been mentioned already. Here's a list of a bunch of them: http://www.augcominc.com/links.html#dv

    If you are in the U.S., your state has a lending program where you may borrow such a device for a trial before you commit to buying one. (And if she recovers speech, you might just use the loaner and not have to buy one at all). Most countries with national health programs have something similar. The hospital's speech therapist probably knows how to contact them.

    If you don't get a satisfactory response from the hospital speech staff, see if your closest university has a Speech-Language Pathology of Communication Sciences and Disorders department. You might be able to get some good advice there.

    Good luck.

    --
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  21. Re:Paper and pencil? by maxwells_deamon · · Score: 5, Informative

    A magna doodle is the way to go if possible. Paper piles up very quickly.

    I had jaw surgery many years ago and went to the toy stores beforehand to get a couple of magic slates and they had just come out with the magna doodle so I bought one.

    After the surgery, at the start of each of the first 4 shifts a nurse would come into my room and see it and say "OMG where did you get this?" "Could I borrow it for the floor meeting, Please" It would go away for a half hour and then come back. They did lots of jaw surgeries on that floor and were very tired of papers laying everywhere.

    As I was wired shut for 7 weeks I even took it with me afterwards to shop and such.

    Just make sure you write her name on the frame so she gets it back.

  22. Re:Paper and pencil? by Jah-Wren+Ryel · · Score: 3, Funny

    Why must hi-tech be the answer? Because this is slashdot.org.

    Low tech is handled by luddite.org.
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  23. What are you thinking? Have some common sense. by dircha · · Score: 3, Insightful

    This is sort of like when some technology guys decides that if we can just get computers running Linux into sub-Saharan Africa, we'll save the world.

    If your grandmother is on a respirator, the last thing she needs is for someone to interrogate her. She's your grandmother, not a dying secret agent.

    Listen, just be with her where she can see you. Read a book. Hold her hand. Talk gently to her. Tell her that you're there. Tell her who is in the room with her. Tell her who is coming to see her. Tell her about news in the family. Tell her what your children have been up to.

    You know, things people have done for thousands of years to comfort their loved ones who have fallen ill?

    Turn off your ipod and your blackberry and think a little, man. Technology may not cause cancer, but apparently it has an affect on common sense.

    1. Re:What are you thinking? Have some common sense. by arb+phd+slp · · Score: 2, Insightful
      This is awful advice. What about the question made it sound like the family wasn't already spending time with her, talking gently and being reassuring? Up until now they've been trying to communicate and it has not been effective. She is not in a coma, she still has information to contribute.

      The last thing she really needs is to be told that the things she has to say don't matter.

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    2. Re:What are you thinking? Have some common sense. by YoungHack · · Score: 2, Insightful

      > If your grandmother is on a respirator, the last thing she needs is for someone to interrogate her. She's your grandmother, not a dying secret agent.

      You sir have no idea what you are talking about. I had a close family member who was unable to communicate for weeks (among other disabilities). She said that was absolutely the worst part of her hospital experience.

      Talking to a person who wants to talk back is little comfort. Being unable to communicate is being in prison, solitary confinement, whether there are other people there or not.