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Our speech-language pathologists are available to support a wide range of assessment and intervention needs. We are committed to providing customized strategies that can support effective communication and interactions throughout recovery.

Assessment considerations

All bedside evaluations at Boston Children’s Hospital begin with careful review of the patient’s medical chart, communication with key stakeholders (e.g. caregivers and providers), and a feature-matched assessment. A feature-matched assessment is “a systematic process by which a person’s strengths, abilities, and needs are matched to available tools and strategies” (Shane and Costello, 1994). In the ICU/acute care environment, a variety of factors, strengths, skills, and needs are evaluated to ensure proper provision of strategies throughout the continuum of care. Ongoing re-evaluation in this environment is essential given patients’ often changing medical statuses and, subsequently, their changing abilities to access different tools and strategies as they recover.

  • Speech skills
  • Language skills
  • Physical access
  • Cognition
  • Vision, hearing, and sensory needs
  • Medical status and interventions
  • Literacy skills
  • Positioning
  • Caregivers, stakeholders, and communication partners
  • Patient and family preferences
  • Environment
  • And more

The ability to reliably access the nurse-call system while inpatient is of utmost importance for patients, families, and staff. Patients who are unable to physically access the standard nurse-call buttons may be assessed for alternative access methods and assistive technology solutions to ensure the ability to call for help. Various switch sizes, mounting tools, and set-up options are available following a bedside assessment and/or in collaboration with Engineering. Our clinicians also work with occupational therapists as indicated to ensure appropriate access needs are met.

Intervention considerations

Upon completion of a bedside assessment, the speech-language pathologist may provide the following interventions:

  • Support use of a baseline communication system in the hospital setting
  • Modify or enhance current communication systems as needed to add new vocabulary, explore bedside mounting options, and support physical access needs
  • Design and construct AAC systems and strategies to meet new communication needs
  • Provide visual aids to enhance comprehension, anticipation, and participation
  • Explore presentation strategies for patients in need, such as partner-assisted scanning or switch-scanning
  • Explore optimal communication access options
  • Educate and train communication partners, including provision of bedside signage
  • Set up adapted nurse-call system and tools for gaining nurse or family attention
  • Educate staff and document about how the patient communicates
  • Identify patients who are appropriate for referral to our outpatient department

Intervention strategies

At Boston Children’s Hospital, we strive to have a wide variety of tools and strategies available for a patient’s use during a hospitalization of any length. Recommended strategies may include high-tech systems, low-tech systems, or no-tech systems. Recommendations are always determined relative to a patient’s current level of skill and need based on a feature-matched assessment, and they may change throughout the recovery process. Depending on a patient’s status, the following communicative functions may be addressed using a variety of tools and strategies:

  • Gaining attention, for example calling a nurse or loved one for help
  • Expression or comprehension of medical needs
  • Social interaction
  • Making choices and indicating preferences
  • Feeling in control
  • Asking questions
  • Regulating activities
    • Opt in or out
    • Take a break
  • Commenting
  • Expressing one’s personality
  • And so much more

For many pediatric patients, use of external tools and systems may not be appropriate or accessible during their time in the hospital. Rather, use of unaided communication strategies, including gestures, facial expressions, sign language, body movements, eye movements, and others, may be the most suitable strategy. Unaided strategies may be used in combination with aided strategies, or those that incorporate external tools and materials.

Often, technology is not required for a patient to effectively communicate a wide variety of messages in the hospital setting. Our speech-language pathologists strive to customize and individualize all low-tech materials to meet the needs of our patients, as years of service delivery have revealed that a “one-size-fits-all” model does not always apply to this setting. Communication boards, visual aids, picture-symbol cards, written text, and other low-tech materials are made available to our patients throughout the hospital.

With the ever-changing and evolving use of higher technology systems in AAC, we are committed to having a broad range of high-tech communication systems readily available to patients for whom technology serves as the best feature-matched communication tool while inpatient. These tools include voice-output communication aids, multilevel speech-generating devices, dedicated dynamic speech-generating devices, text-to-speech systems, and various speech-generating applications.

Patient rooms, especially in the ICU, are typically dense with medical equipment and require space for nurses and physicians to access patients and their medical devices quickly and easily. Provision of communication systems therefore requires careful placement and access at the bedside. A wide range of mounting systems are available for patient use including:

  • Bedside arms to mount switches, tablets, and lightweight communication systems
  • Wedges and angled mounts for proximal switch placement in beds
  • Rolling over-the-bed floor mounts for larger and/or heavier speech-generating devices
  • Access switches, sip and puff switch, and mounts for patients with limited mobility, quadraparesis, or quadraparalysis
  • Eye-gaze frames and related display mounts
  • If a patient requires specialized mounting equipment, our team can collaborate with inpatient and outpatient OTs to ensure accessible options are explored.

Partner-assisted scanning is a strategy used by the communication partner to help a patient quickly scan through message groups and choices in a communication system. This strategy is often encouraged when the patient’s ability to independently point to letters or messages on a communication board or system is challenging due to physical or visual impairments. We created this tabbed communication flipbook that patients may utilize as one potential strategy. This video describes implementation.

Some patients with reduced physical skills may be appropriate for switch-scanning to access a speech-generative device. By activating one or two switches, a patient can scan through messages on a communication system, make a selection, and communicate messages using digital or synthesized voice output. Switches and communication systems are carefully mounted and placed at the bedside to ensure timely and appropriate activation.

Often, displaying information related to how a patient communicates in the room can change the entire dynamic of a bedside conversation. Alerting providers about a patient’s communication preferences and needs, as well as displaying information related to equipment provision and set up, can help ensure successful interactions. We encourage patients and families to think about creating signage to post at bedside ahead of a planned admission when able.

Communication planning

When a surgical procedure or hospital admission is planned, we encourage patients who use AAC to bring supportive tools and strategies to the hospital for use while inpatient. Access to familiar, customized, and comfortable tools and strategies can make a world of difference during hospital encounters. Creating a “communication passport” or “hospital passport” can also help patients inform their providers about their unique needs.

Patients and families may consider a variety of factors to prepare for a potential hospital encounter:

  1. Bring your child’s AAC systems and/or strategies.
  2. Talk to your medical team about what to expect during the planned hospital encounter.
  3. Create and bring a “communication passport” outlining your/your child’s communication needs and preferences.
  4. Pack a “go bag” with essentials such as baseline or backup communication tools, mounting equipment as indicated, chargers, familiar toys and comfort items, and more.
  5. Connect with your child’s speech-language pathologist. Your child’s SLP may be able to support vocabulary selection, communication system modification, and other needs to make sure your child is prepared and able to communicate during their hospitalization.
  6. If a temporary loss of speech is anticipated or if you suspect your child may have difficulty communicating while in the hospital, have your medical team contact our inpatient SLPs for support.

For many children and young adults, a visit to the hospital can be a scary and worrisome experience. Children with complex communication needs often benefit from accessing developmentally appropriate information prior to the inpatient hospital stay to enhance understanding and anticipation of predictable events or experiences. Our inpatient speech-language pathologists worked with Child Life Services and other providers across the hospital to create a variety of Social Stories™, known as My Hospital Stories. These stories, which can be found and downloaded on the Boston Children's website, provide a visual guide to patients’ hospital visits.

Since some children with complex communication needs understand information in different ways, customized Social Stories™ can be created by contacting our inpatient team prior to your child’s hospitalization.

Materials to help you prepare: