Communication Barriers for the Spinal Cord Injury Patient

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Communication Barriers for the Spinal Cord Injury
Patient

• Thilo Kroll, PhD
• Brenda Gilmore, BFA SCI Life Consultant
• NRH Center for Health Disability Research

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Goals

• To identify communication issues and needs when
  interacting with people with SCI and other
  disabilities
• To determine critical communication skills
• To identify strategies to improve communication
  with individuals who have disabilities

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The Consumer-Professional Partnership Program

• Consumers co-present in education settings for
  health care professionals
• The SCI Life Educator Concept
• Training Manual
• 3 Core Modules Disability Awareness and
  Communication Prevention of Secondary
  Conditions, Physical Activity and Exercise

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Definition Communication

• The act of communicating transmission.
• The exchange of thoughts, messages, or
  information, as by speech, signals, writing, or
  behavior.
• Interpersonal rapport.

The American Heritage Dictionary of the English
Language, Fourth Edition 2004 Houghton Mifflin
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Why communication?

• Rapport building
• Accuracy in exchange of information
• Receptiveness of information
• Cooperation in treatment and rehabilitation
• Prevention of secondary conditions and medical
  complications
• General respect

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Types of Communication Barriers

• Physical/Individual
• Attitudes and Behaviors
• Environmental

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Physical

• Changes in the ability to communicate verbally
• Changes in communication due to functional
  limitations (use of arms) and body position
  (wheelchair)

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Attitudes and Behaviors

• Halo-Effect Physical limitations in specific
  functions are interpreted in terms of limitations
  of the person
• Confounding physical, cognitive and linguistic
  abilities
• Stereotyping
• Lack of knowledge about SCI
• Lack of attention to issues other than SCI
• Preventive screenings, sexuality, exercise,
  wellness

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Environmental Barriers

• Transportation
• Availability
• Timeliness
• Cost

• Office accessibility
• Parking
• Elevators and doorways
• Examination rooms
• Diagnostic Equipment
• Staff communication

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Strategies for Addressing Communication Barriers
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Physical

• Be patient!
• Hold eye contact
• Explore alternative ways to verbal communication
• When speaking to a relative, acknowledge the
  patient through eye contact and direct address
• Dont forget to respectfully acknowledge
  individual as a person first with a unique
  biography, personal interests, needs and skills

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Attitudes and behaviors

• Person with a disability is a person first, a
  patient second, and an individual with special
  needs third
• Dont make assumptions or jump to quick
  conclusions about the reasons they come to see
  you
• Approach the individual with a disability just
  like everyone else

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Attitudes and Behaviors (continued)

• Dont make assumptions about the social life of
  people with disabilities
• Do not automatically provide assistance
• Make sure you look at and talk directly to the
  person with a disability

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Environment

• Be flexible in time allotted for appointments
• Tardiness may be beyond patients control due to
  transportation, assistance issues

• Make office experience as easy as possible for
  patient in a wheelchair
• Provide information on office layout and
  available support
• Inquire about assistance needs

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Communication Ground Rules
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Introductions and General Communication Rules

• Use a normal tone of voice when extending a
  verbal welcome. Do not raise your voice unless
  requested.
• When introduced to a person with a disability, it
  is appropriate to offer to shake hands.

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Ground Rules (continued)

• Shaking hands with the left hand is acceptable.
• For those who cannot shake hands, touch the
  person on the shoulder or arm to welcome and
  acknowledge their presence.

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Ground Rules (continued)

• Treat adults in a manner befitting adults
• When addressing a person who uses a wheelchair,
  never lean on the person's wheelchair since the
  chair is part of his or her personal space
• When talking with a person with a disability,
  look at and speak directly to that person and not
  through a personal assistant or family

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Ground Rules (continued)

• Offering assistance
• Introduce yourself and offer assistance.
• Don't be offended if your assistance is not
  needed. Dont proceed with assistance!
• Ask how you can help and follow instructions.
• Be courteous, but NOT condescending.
• Assist when necessary or requested, but do not
  discourage their active participation

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Ground Rules (continued)

• When offering help with bags or carrying items
  inquire whether you may help
• Do not hand a cane or crutches unless the
  individual requests this.

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Use of Terminology
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Use of appropriate terminology

• Awareness of language and terminology is critical
  for the development of a trusting relationship
  between the individual with a disability and the
  healthcare provider
• In the medical community it is not uncommon to
  identify people by their condition as if that
  constitutes their whole identity.

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Terminology
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Working with Peers
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Working with peers

• To develop a better understanding of disability
• To establish a bridge to the community
• To provide effective social role models
• To identify communication and social issues that
  challenge rehabilitation efforts
• Example NRH SCI Peer Mentor Program

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Conclusion

• Patients and health care professionals benefit
  from open, continuous, and respectful
  communication
• For further information on the Consumer-Profession
  al Partnership Program visit our website
  www.sci-health.org/cppp
• Contact Brenda.Gilmore_at_medstar.net
• Thilo.Kroll_at_medstar.net