Tuesday, 13 May 2014

Bolt Burdon Kemp: Communicate, Communicate, Communicate!

I am honoured to have been invited by the Association of Personal Injury Lawyers (@APIL) to give a presentation at their Advanced Brain and Spinal Cord Injury conference in July on the topic: Alternative and Augmentive Technology in Communications.

This is such a huge and fascinating topic that I am going to really struggle to keep within my allotted 15 minute slot.  The most I can hope to achieve in this short time is provide an overview of the territory for busy legal practitioners acting for clients with complex communication needs.  

So: what should a person who faces communication challenges expect their specialist solicitor to know to be confident that they will receive the right amount of compensation for this aspect of their injuries?  What is the territory a lawyer should be familiar with in order to know how to investigate and obtain persuasive evidence to support this part of the claim? What role should the solicitor play in this investigation and gathering of evidence?

In my view, that solicitor should, first and foremost, understand and appreciate what is meant by “communication”.   At its most basic level, communication is the process by which one person gives information to or receives information from another person.  But it is also much more than this.  It is through communication that we share our thoughts, beliefs, feelings and ideas, build relationships with others and learn new things.  Effective communication is essential for learning and development, personal care, social engagement, education and employment. It is also an essential component of quality care and patient safety. Through communication we can express who we really are and define our unique identity to those around us.  Communication can be spoken, but it can also take on other forms such as writing and can also be in the form of facial expressions, behaviour, body language or gesture. It can be through the use of sign language or a common set of symbols or – increasingly for everyone - through a communication device. Without this understanding and appreciation, the solicitor is in real danger of undervaluing the importance communication plays in determining a person’s quality of life.

It goes without saying that a specialist solicitor must make every effort to fully explore the specific communication challenges that his or her individual client faces, both now and in the years to come.  An adult with a spinal cord injury at the level of T1 and below is likely to be able to meet all his or her communication needs. By contrast, a two year old with a high level injury requiring ventilation will not only be reliant on, for example, sip and puff switch technology to interact with her environment and those around her, but as a “beginning communicator” will have special educational needs requiring adapted play activities designed to foster the development of her communication skills.  She will need to develop language and literacy, acquire skills for making choices, requesting, rejecting and making decisions and learn strategies for social interaction, including turn taking and repairing communication breakdown.  She will require support to learn how to use alternative access, such as eye pointing and scanning and as her skills develop, so her needs will change.

How should a solicitor explore the specific challenges facing his or her client?  Identifying the right team of experts for each individual client is absolutely critical and adopting a multidisciplinary approach to assessment is invariably necessary.   The individual with complex communication needs is the key team member, along with family members and others who will also use the technology; those others will, of course,  change as the individual makes life transitions, for example from school to university.  The solicitor needs to gather in information about his or her client’s physical and mobility capabilities, their cognitive and linguistic capabilities and their literacy, sensory and perceptual skills. The solicitor should obtain relevant medical and educational records and expert opinion in the relevant fields of expertise, such as occupational and/or physical therapy, educational psychology, neurology, neuropsychology, paediatrics and speech and language therapy. But the solicitor also needs to think laterally to ensure that all those who may be affected by any decisions made are also involved. If, for example, a general or special needs teacher, who is responsible for managing a child’s educational environment, is excluded from the team, relevant information may be missed and, more fundamentally, any recommended intervention is more likely to fail through lack of “buy in”.

Mobility, motor or movement impairments can limit access to literacy materials and technology, so occupational and/or physical therapy input is essential to ensure maximal positioning and seating as well as to identify the most effective and efficient access methods, which can range from no- or low-tech, such as mouth stick, for pushing keyboard keys, large-print key labels, alternative keyboards and joysticks,  to high tech, including head mouse, speech recognition, screen reading software, screen magnification software and speech generating devices. 

It helps if a solicitor has some knowledge of the strategies and technologies that are “out there” to help someone with complex communication needs. Increasingly though, much technology that was once considered to be alternative or specially adapted is now very much mainstream.  Who doesn’t know how to control a touch screen device or hasn’t used face recognition on a digital camera?  You can even, if you have a computer with an inbuilt camera, get your own free “eye gaze” technology by downloading “CameraMouse” http://www.cameramouse.org/ and control the mouse pointer on your computer screen just by moving your head. More important than the increasing ubiquity of alternative and augmentive technology, though, is that the pace of change in this field is so fast that it is practically impossible to keep track.  While Speech, Language and Communication Therapists should have up to date knowledge of a wide range of AAC methods including high-tech communication systems as part of their general expertise, a specialist solicitor would consult an expert Assistive Technologist for cutting edge knowledge of current and emerging Technologies.

What should my “take home” message to the conference be?  I think it should be: “Don’t underestimate the value of communication for your client’s quality of life, or the challenge of investigating and preparing the evidence for this part of the claim.” Not very snappy, I’ll admit. Any better ideas?

Jo Chapman is a Partner at Bolt Burdon Kemp and specialises in clinical negligence claims. Jo has years of experience of acting for seriously injured clients. 
If you or a member of your family have complex communication needs as a result of a spinal cord injury and/or traumatic brain injury caused by someone else’s negligence contact us online or call 0808 1596 075 for expert advice from our dedicated team.

Jo Chapman

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