ACQ Vol 12 No 2 2010

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94 ACQ Volume 12, Number 2 2010 ACQuiring knowledge in speech, language and hearing
aided language and Makaton key word signing facilitate oral
language. However, if Mandy is not convinced by Bev’s
information, it is her right to refuse to use aided language.
This would be very difficult for Bev, who knows how
important this is for the development of communication.
Professional integrity: Bev is not a Makaton trainer, but could
show Mandy some signs and refer her to the Makaton DVD.
She could show Mandy and the teachers how to encourage
Jenny to sign using the “hand-over-hand” technique (http://
. She could also assist
Mandy by informing her about the Adapted Learning website
), a website set up by Boardmaker™
for parents to share picture based resources. She could
inform Mandy about Boardmaker™ and try to encourage the
local library to purchase it. She realises the need to respond
to the many opportunity barriers, but does not have sufficient
hours to do so as effectively as she would like. She knows
that unless Mandy and Jenny’s teachers are motivated,
Jenny’s progress in learning Makaton will be slower than it
should be.
Case scenario: Rachel
Background
Rachel is a 21-year-old woman with traumatic brain injury
due to a hit-and-run car accident. While she is able to walk,
her fine motor skills have not improved as well as the health
professionals expected. Her parents and some family
members can understand her dysarthric speech, but she is
not understood by people who do not know her. She has a
Lightwriter™ but due to a tremor in her better hand, her
access is slow. She also has some problems with her
memory.
Rachel’s court case is scheduled for one month’s time.
She is determined to give evidence in court, but is very
anxious that she will not be understood, that she will be
slow when using her Lightwriter™, and that her evidence
will not be taken at full value. When giving evidence,
Rachel will need a communication assistant/facilitator to
assist in the interpretation of her speech or to convey the
messages composed on the Lightwriter™. At their last
speech pathology session funded by the Transport Accident
Commission (TAC;
homepage/home.jsp?gclid=CJHqsuyswJ0CFc0vpAodgB
RssA), Rachel’s speech pathologist, Susie, suggested that
she have a word-based communication board made up,
with sentences and phrases in case she becomes fatigued
during the long hearing. It may also help her remember some
important points she wishes to make. Rachel wants her
speech pathologist to support her in court, but Susie has not
been funded by TAC for this purpose.
Mandy is also concerned that if she introduces other ways
of communicating, Jenny will never learn to speak. Bev
can only offer her services monthly according to the service
model of her organisation because of the demand for
speech pathology services in her region.
Ethical dilemmas
Beneficence / non-maleficence: Bev has a good
understanding of what Jenny needs and the critical
importance of introducing communication strategies
immediately. She has the skills to offer the support needed,
but does not know how she will do all this within a monthly
visit of 2 hours. If Bev does not provide support both to mum
and the teachers there is the potential for maleficence in that
negative attitudes will develop towards the communication
intervention and towards Jenny, placing strain on the system.
Bev is very aware that Mandy is already feeling stressed by
all the intervention Jenny will need. Bev realises that her
hours with the family would be most beneficial if directed to
developing Mandy’s skills and confidence in facilitating
Jenny’s communication and to working with the teachers,
rather than working directly with Jenny.
Truth: There is evidence of the importance of early
intervention for AAC in establishing patterns for active
communication, for cognitive development, and for social
participation. Visual aids provide an immediate form of
communication, but have to be designed, produced, and
introduced in all communication environments. Makaton key
word signing is an unaided strategy and Jenny has
responded well to gesture, so there is good likelihood that
Jenny will take to Makaton. It is also very effective in
conveying meaning, but the system must be learnt by
Mandy and Jenny’s brother as well as the teachers. Bev also
sees the potential for a basic electronic communication aid
which she will need to apply for, and which again will require
training and monitoring.
Justice: Bev needs many more funded hours for an effective
AAC intervention. In addition to applying for the
communication device, she needs to motivate and lobby for
a class aide for Jenny. Travelling to a centre where a
Makaton course may be held is not an option for Mandy, but
it is possible for her to purchase a DVD and learn Makaton
signing that way. This will require her to be very committed to
the task. A class aide would take much pressure off the
teachers, but Bev still needs to go through the process of
applying, and it may take time.
Autonomy: Mandy has reservations about Makaton and
aided language which will impact on her attitude to learning
and implementing the communication strategies. Bev needs
to counsel Mandy to help her understand the evidence that