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Communication Partner Training

Last update: 29 Oct 2016

► People with severe cerebral palsy should be given all the support available to communicate their needs and wants
► Augmentative and alternative communication (AAC) can enhance the exchange of information between the user and their family, friends and carers (also called communication partners)
► To maximise the benefit, communication partners of people with cerebral palsy should be offered training to optimise the use of their AAC device.

Who is it for?

For someone with cerebral palsy who has trouble speaking and writing, augmentative and alternative communication (AAC) can supplement or replace speech and writing. Training is essential for the person’s communication partner (often their parent) to support the use of AAC strategies. Communication partner training may assist the communication partners of individuals with these characteristics:
Age: Infants and Toddlers, Preschoolers, School-aged, Adolescents, Adults, Older adults, Family members and carers
Type of cerebral palsy : Bilateral cerebral palsy, Diplegia, Hemiplegia, Quadriplegia, Triplegia, Unilateral cerebral palsy

More information about cerebral palsy is contained in the What is CP? section.

Mobility : GMFCS I, GMFCS II, GMFCS III, GMFCS IV, GMFCS V

Gross Motor Function Classification System (GMFCS) – classifies severity of mobility difficulties of children and adolescents with CP.

GMFCS Level I
Walks without limitations in the home and community, climbs stairs and can run and jump, difficulties with speed and coordination.

GMFCS Level II
Walks with limitations, difficulties with long distances and uneven surfaces, uses a railing for climbing stairs, limited running and jumping.

GMFCS Level III
Walks using a hand-held mobility device such as crutches or walking frame, may use wheeled mobility for long distances.

GMFCS Level IV
Usually relies on wheeled mobility with assistance, may use powered mobility, usually needs special seating and assistance with transfers.

GMFCS Level V
Usually transported in a manual wheelchair, requires specialised seating and full assistance for transfers.

Arm ability : MACS I, MACS II, MACS III, MACS IV, MACS V

Manual Ability Classification System (MACS) – classifies severity of upper limb impairment: how children with cerebral palsy use their hands to handle objects in daily activities in the home, school, and community settings.

MACS Level I
Handles objects easily and successfully.

MACS Level II
Handles most objects but with somewhat reduced quality and/or speed of achievement.

MACS Level III
Handles objects with difficulty; needs help to prepare and/or modify activities.

MACS Level IV
Handles a limited selection of easily managed objects in adapted situations.

MACS Level V
Does not handle objects and has severely limited ability to perform even simple actions.

Communication ability : CFCS II, CFCS III, CFCS IV, CFCS V

Communication Function Classification System (CFCS) – classifies severity of everyday communication of people with cerebral palsy.

CFCS Level I
Effective Sender and Receiver with unfamiliar and familiar partners.

CFCS Level II
Effective but slower paced Sender and/or Receiver with unfamiliar and/or familiar partners.

CFCS Level III
Effective Sender and Receiver with familiar partners.

CFCS Level IV
Inconsistent Sender and/or Receiver with familiar partners.

CFCS Level V
Seldom effective Sender and Receiver even with familiar partners.

Movement disorder : Ataxia, Athetosis, Dystonia, Hypotonia, Spasticity

More information about movement disorders can be found on our websites.

Intellectual ability : No intellectual disability, Mild intellectual disability, Moderate intellectual disability, Severe intellectual disability

A person’s thinking skills – ability to understand ideas, learn and solve problems. People with intellectual disability have difficulty with intellectual functioning which may influence learning, communication, social and daily living skills. Intellectual disability may be mild to very severe.

Who can assist?

Specialist speech pathologists can support the communication partners of people with cerebral palsy to help them converse using augmentative and alternative communication (AAC).

Speech pathologists at Cerebral Palsy Alliance will help you decide whether AAC might be appropriate for you and your family. Communication partner training will be offered as part of learning to use AAC effectively.

Find a Cerebral Palsy Alliance service

Fees

Fees will apply for sessions to support the communication partner to converse with the person using augmentative and alternative communication. Fees will depend on the service provider, the number of sessions and the kind of communication partner training. Check with the service provider to see if there will be additional costs to develop a home program, therapist travel to the sessions or to prepare reports. Ask service providers if you are eligible for funding to assist with fees. People with a disability living in Australia may also be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme (NDIS).

Time

The time required for a communication partner to become competent and comfortable with augmentative and alternative communication (AAC) strategies will depend on the AAC user, complexity of the communication method, and the knowledge, attitude and prior experience of the communication partner. Training may take longer if there are multiple communication partners and a variety of environments where communication needs to occur.

More about communication partner training

Communication challenges are common for children and adults with cerebral palsy. For a person with cerebral palsy who has communication difficulties, being able to express needs and wants can have a significant impact on wellbeing and their sense of control.

A person with cerebral palsy should have the opportunity to use augmentative and alternative communication (AAC) effectively in all their environments. For this to occur, it is very important that communication partners such as parents, carers, teachers and peers are competent and comfortable using AAC in these environments too. That is where communication partner training comes in. It provides partners with education, knowledge and resources to support people with cerebral palsy to use AAC. This can help make communication with, and amongst, children and adults with cerebral palsy as clear and meaningful as possible. Training will vary according to the communication partner and the environments in which they communicate.

Aided communication

Augmentative and alternative communication (AAC) methods can be aided or unaided. Aided AAC uses external items (aids) to assist a person with their communication. It can be ‘low tech’; for example, using pictures or symbols arranged in communication books and boards as communication aids. Alternatively, it can be ‘high tech’, involving technologies such as speech-generating devices.

Unaided AAC, which is not explored on this page, involves using sign language or gestures to communicate1.

Training examples

Speech pathologists frequently help communication partners such as parents, carers, teachers, teachers’ aides and classroom peers learn strategies that help aided augmentative and alternative communication (AAC) users communicate in different environments such as home, school and the community. Strategies include:

  • Ensuring the AAC is available and positioned ready for use
  • Creating opportunities for communication using AAC, for example, encouraging the user to request a desired object by placing it out of their reach
  • Encouraging turn-taking in communication and allowing enough time for AAC users to respond
  • Modelling the ways that AAC can be used. With this strategy, the communication partner may combine speech and the corresponding symbols on the AAC device during conversation. This is also called aided language stimulation
  • Educating communication partners on how to use the device and software so they can customise and adapt AAC systems to meet the needs of the user.

Things to note

  • Communication partner training can also be called communication partner instruction, instructional training, parent, teacher or peer instruction, and interaction training
  • It is sometimes offered in groups, for instance to groups of teachers, carers or students who are communicating with augmentative and alternative communication users in schools. It may also be offered to individuals such as family members
  • Ongoing education and coaching or one-off training may be offered.

Best available research evidence

Where did we search?

We searched the allied health, medical and educational literature to find research evaluating the outcomes of communication partner training that has been implemented with children and adults with cerebral palsy who use aided augmentative and alternative communication.

What were we looking for?

The search aimed to find the best available research into whether this intervention improved the functional communication of aided augmentative and alternative communication users and the skills used by their communication partners.

What did we find?

The best available evidence was a systematic review2 and six single case experimental design studies3-8. The systematic review focused on communication outcomes of augmentative and alternative communication (AAC) users resulting from communication partner training. Four of the single case experimental design studies included evaluation of the skills learned by communication partners of children with cerebral palsy or other disabilities who had complex communication needs3-6. The remaining studies examined outcomes for adults with significant intellectual or physical disability7-8.

For children with cerebral palsy, moderate quality research provides evidence that communication partner training is effective for teaching skills to communication partners and improving the interactions of children with cerebral palsy. Communication partner training of all people supporting children who use AAC is recommended as worthwhile and should be integrated with the prescription and implementation of aided AAC.

For adults with cerebral palsy, the quality of research evidence evaluating communication partner training is very low. This is because there were only two studies involving three participants.

Research evidence is just one piece of information used to make decisions about an intervention. The results of the reviewed studies provide support for communication partner training. AAC is used to promote social communication and a means for the person to adequately express their needs and wants. It makes sense to implement communication partner training as part of AAC to ensure that primary people in the user’s environment understand how to use and modify the system and provide appropriate prompts and strategies to encourage effective use of these strategies.

Children

Communication outcomes of children: The results of the studies indicated that children initiated communication more often and increased the number of interactions with their communication partners2-3 including teachers, teachers’ aides, parents, caregivers and classroom peers.

Communication partner outcomes: Communication partners successfully learned and carried out the strategies taught as part of communication partner training3-6. They provided more opportunities for social interaction with the children using aided AAC. Communication partners generally continued to use the strategies after their training ceased.

Effective training components: Communication partner training appeared to be more effective when it was systematically implemented and included a number of specific learning strategies including a descriptive overview of communication partner training, demonstration of implementing strategies, verbal rehearsal of skills, role play of the strategies, and supervised practice of the skills learned.

Adults

One study evaluated training completed with four different communication partners of one adult with severe intellectual disability7. The partners increased their use of most strategies, but the changes were not sustained after training stopped. The AAC user in the study increased the number of times she initiated communication with her partners. In the second study8, two adult users each had communication partners instructed to support their communication. They both used more complex communications afterwards, and the partners facilitated more opportunities for equal communication and controlled the interaction less.

Date of literature searches: February 2016

  1. Speech Pathology Australia. Augmentative and Alternative Communication. Factsheet available here. Accessed on May 5 2016.
  2. Kent-Walsh, J., Murza, K.A., Malani, M.D., & Binger, C. (2015). Effects of communication partner instruction on the communication of individuals using AAC: A meta-analysis. Augmentative and Alternative Communication, 31(4), 271-284.
  3. Douglas, S.N., Light, J.C., & McNaughton, D.B. (2013). Teaching paraeducators to support the communication of young children with complex communication needs. Topics in Early Childhood Special Education, 33(2), 91-101. See abstract
  4. Binger, C., Kent-Walsh, J., Ewing, C., & Taylor, S. (2010). Teaching educational assistants to facilitate the multisymbol message productions of young students who require augmentative and alternative communication. American Journal of Speech-Language Pathology, 19, 108-120. See abstract
  5. Carter, M., & Maxwell, K. (1998). Promoting interaction with children using augmentative communication through a peer‐directed intervention. International Journal of Disability, Development and Education, 45(1), 75-96. See abstract
  6. Kent-Walsh, J., Binger, C., & Hasham, Z. (2010). Effects of parent instruction on the symbolic communication of children using augmentative and alternative communication during storybook reading. American Journal of Speech-Language Pathology, 19, 97-107. See abstract
  7. Ogletree, B.T., Bartholomew, P., Kirksey, M.L., Guenigsman, A., Hambrecht, G., Price, J., & Wofford, M.C. (2016). Communication training supporting an AAC user with severe intellectual disability: Application of the communication partner instruction model. Journal of Developmental and Physical Disabilities, 28(1), 135-152.
  8. Add in Light et al. Light, J., Dattilo, J., English, J., Gutierrez, L., & Hartz, J. (1992). Instructing Facilitators to Support the Communication of People Who Use Augmentative Communication Systems. Journal of Speech and Hearing Research, 35(4), 865-75. See abstract
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