She understands everything I say…

How many times have we heard this said about people with severe disabilities? As a speech pathologist I often think about how I know if someone understands what I am saying to them and what I need to do if I think they do not.

Why does it matter?

Everyone deserves to be understood and their wishes respected regardless of their ability level. But, how do we really respect someone’s wishes if we do not understand their communication skills and limitations. It is important to remember that not everyone understands speech. I know this can be hard to accept – particularly when the person you are talking to is an adult. But, the reality is, some people with severe disabilities find that understanding speech alone is just too hard. That does not mean we stop talking to people but it does mean being aware of how many other cues we might be using that allows someone to get the gist of what we are saying to them.

car keys

Holding up car keys as a signal to go home is an example of how messages can be understood without the need for speech.

Apparently only 35% of our speech is understood through words alone. Gestures, facial expression, body language, use of pictures and objects actually make up the rest. We know this from our own life experience. How many of us have been to a noisy bar and a friend has motioned a drink gesture and we have nodded in agreement. Or, held up the keys to the car and got the attention of our partner across a crowded room as a signal to go home. The message has been understood without the need for speech.

I have often been in situations where I have questioned whether the person with a severe communication disability has actually understood what has been said to them. A recent example was when I watched an interaction at the end of a meal. The support worker asked the person to take their plate to the sink. They pointed to the plate and then to the sink. Then they beckoned to the person and touched the back of the chair and asked the person if they would like tea, coffee or milo. This time, they got out the teabags, the jar of coffee and the tin of milo. Then, they signed the word spoon and got a spoon out of the drawer and pointed to the fridge and said “Can you get the milk?” Afterwards, the support worker said “See, she understands everything I say.”
I did not think the person understood everything that was said. But, what I saw was a successful interaction based on the use of speech and other cues.

There were a number of cues that helped that situation:

1)         Routine – at the end of a meal we generally take our dirty dishes to the sink

2)         “Do what you usually do in a situation” e.g. sit on the chair that is indicated

3)         Use objects that relate to the activity

4)        Use natural gesture or sign (where the sign visually relates to the concept or object talked about)

5)         Accompany use of objects and gesture with speech. People respond to tone of voice even if they do not understand speech alone

6)         (Do what others do in the same situation – even if you are not sure, following the crowd works more often than not).

I did not see the last cue but I was told that this person will often get their bag and go to the door when they see their peers head off in that direction.

A number of informal and one formal strategy i.e. the use of the Auslan sign “spoon” were used in that brief exchange. And more could have been done in that situation but it would have meant more planning and effort by the more able communication partner.

The options available to help understanding involve either unaided e.g. use of sign and gesture or aided e.g. use of pictures or photos strategies.

Using Key Word Sign (unaided communication) – Using simple sign and gesture with people who have difficulty understanding helps them understand the spoken word by relying on the visual cue of the sign. Teaching and learning simple signs has now been made much easier with the release of the Key Word Sign Australia App. This has access to over 600 line drawings and can be used to create individualised communication resources. It is also possible to attend Key Word Sign workshops to learn basic signing skills. Visit the Key Word Sign Victoria website for details.

Using objects and communication aids (aided communication) – If remembering manual signs is difficult, you could use pictures or objects. Scope’s Non-electronic Communication Aid Service develops communication aids, completely individualised to your needs.  (NECAS - or get the Tools2Talk+ App ( ) and do it yourself.

The person may not understand everything you say but there are many things you can do to make comprehension easier.

By Karen Bloomberg & Hilary Johnson