Importance of Non Verbal Communication

Currently I am on my neuro outpatients prac which has really highlighted for me the importance of non verbal communication.

Last week I treated a patient who has had a bilateral pontine infarction. Basically this patient has limited movement of her upper limbs, lower limbs, trunk and aphasic. Upon reading her patient notes I became quite stressed thinking in my head “how do I communicate with this women?” She arrived and on her lap was a mini keyboard which she communicated thru (spoke on her behalf) using one of her fingers to press the appropriate letters.

At first I kind of froze… I was not used to speaking to someone who did not respond back to me immediately. However throughout the session I became more comfortable. I began to really recognize ways of understanding someone non verbally. With this patient I followed her facial expressions, head movements, singular words she typed, and slight noises indicating whether she was uncomfortable or in pain. I found that I could even have a conversation and find out personal information about the patient like her favourite type of music, hobbies etc. Even in how you touch a patient; manual handling, stroking to activate sensory input to parts of the body, pressure of touch etc are forms of non verbal communication which contribute to a PT building patient rapport. I found that my treatment session was quite successful with the pt gaining as much from the session as I had intended

We learn so many skills as future therapists and in our blue assessment forms communication skills contribute a considerable amount. I traditionally have thought this referred more specifically to how you spoke with patients to make them feel comfortable in your hands. I think this situation highlighted to me the importance of non verbal communication. If you can’t speak to someone there are so many ways of building rapport through being more conscious of facial expression, manual handling, touch and body language. I ask anyone to express your thoughts on whether you too have become more conscious of non verbal forms of communication with some of the patients you have seen

Overprotective parents

I am currently on my rural placement which has involved a number of individual assessments with children and their parent(s). Last week I was assessing a 10 year old boy’s motor skills with his mother present. This boy had a condition that affected numerous systems including his growth, vision and co-ordination amongst others. He had been identified as a young child with developmental delay as a result of this condition and had participated in many OT/PT individual and group sessions working on developing his gross and fine motor skills. This was a school aged assessment aimed at tracking his progress and whether or not the PT/OT intervention was assisting his development.

During the subjective interview the mother stated that she had no concerns regrading her son’s gross motor skills and that he appeared to be doing well. However, her next statement undermined this as she mentioned that her son was a ‘very slow runner’ and that he was always picked last for the sports teams during PE. For this reason she lets her son stay home from school on the days sports are on. The therapist and I felt this was because the son did not want to participate, which we could understand (though didn’t agree with) and to prevent him from being bullied at school the mother protected him by allowing him to stay at home (note that this child had a poor attendance record at school and the mother had stated that one of their goals for the term was to improve this – implying that it was the child that wanted to stay home).

I reflected on this and thought whilst it is an important part of developing social skills as well as the benefits of participating in sports in regard to developing motor skills it would be extremely difficult as a parent to watch your child suffering and being unhappy when being repeatedly picked last for every game at school. I could understand if your child was that unhappy you would do everything you could to protect them, especially since this particular boy also had numerous other impairments and challenges in life. However as I was reflecting upon this the boy excitedly told us that it was the cross country carnival the next day and he was really looking forwards to it (even though he said he was ‘pretty slow!’). The mother quickly intervened and said to the boy that he wouldn’t be able to participate and he may have to stay home. The boy got upset at this and a small argument between the two occurred. Once the argument had resolved we continued with the assessment.

As we were completing the assessment I re evaluated what I had thought before. Clearly the mother was preventing her son from participating to protect him, however the son was still keen to join in even though he recognised he wasn’t as strong or fast as the other children in his class. It’s a fine line between protecting the children with disabilities from bullying of the other children that don’t understand and letting them have a go even if it means they may fail.

At the end of the session the therapist and I explained to the son and the mother that his motor skills were developing well but that he still needed to complete the HEP every day. We also added that to further improve his motor skills it would be beneficial for the boy to participate in sports at school or out of school as then he would be able to apply what he does in the HEP into a real context. I realised that we as therapists are only able to guide the parents towards what we feel will assist in the development of their child’s motor skills. It is up to the parent to decide whether they will take this advice or continue to protect their child, whether the child feels as though they need this protection or not.