Typing to Communicate

Typing to communicate or Facilitated Communication (FC) is a form of Alternative and Augmentative Communication (AAC) in which people with disabilities and communication impairments express themselves by pointing (e.g., at pictures, letters, or objects) and, more commonly, by typing (e.g., with a keyboard). The method involves a communication partner who may provide emotional encouragement, communication supports (e.g., monitoring to make sure the person looks at the keyboard and checks for typographical errors), and a variety of physical supports, for example to provide backward resistance, to slow and stabilize the person’s movement, to inhibit impulsive pointing, or support rhythm; the facilitator should never move or lead the person.

It often is referred to as Facilitated Communication Training because the goal is independent typing, nearly independent typing (e.g., a hand on the shoulder or intermittent touch), or a combination of speaking with typing – some individuals have developed the ability to read text aloud and/or to speak before and as they are typing. Typing to communicate promotes access to social interaction, academics, and participation in inclusive schools and communities.

History of Facilitated Communication

What came to be known as Facilitated Communication was discovered independently in several countries. Rosemary Crossley began using physical support to help non-speaking individuals communicate in Australia during the 1970s, and continued to develop the method throughout the following decade. Doug Biklen’s visit to the DEAL Center (Dignity, Education, and Language) in 1989 and subsequent research and publication (“Communication Unbound,” Harvard Educational Review, 1990) led to the rise of FC in the United States during the early 1990s, as well as the establishment of the Facilitated Communication Institute at Syracuse University in 1992. Since then, use of the method has grown and many individuals who once needed significant support have demonstrated the ability to type with no physical touch and/or to read aloud what they are typing. Training from skilled facilitators and coaches can now be found through organizations around the United States and the world. In 2010, after nearly two decades of existence, the Institute changed its name to the Institute on Communication and Inclusion (ICI). The ICI name represents a broadened focus, reflecting lines of research, training, public education, and information dissemination that focus on school and community inclusion, narratives of disability and ability, and disability rights. Its initiatives stress the important relationship of communication to inclusion.

“Autism has been a creative lesson in life for me. My sensory systems seemed to be not matched between my brain’s requests and my body’s agreement to perform the task. I learned this is the motor planning ability that did not exist for me. Many people seem to not understand that not being able to initiate movement, certainly, does not mean that I do not desire that movement.

You call it ‘sensory overload.’  I call it my ‘man overboard’ feeling.  Some of the therapies I do have helped me to speak, to be able to sit in class to absorb information, to hear and comprehend more clearly, to gain internal rhythm that helps in crossing mid-line, and to lose some of the enormous anxiety that my neurological system holds in place.”

Jamie Burke

Who is involved in Facilitated Communication?

Typers and Facilitators

The person who provides support for communication is called a facilitator or communication support person. A facilitator can be a teacher or other professional, a family member, or a friend. The person who receives the support is often referred to as the typer, communication aid user, or FC user. At the ICI, we use the terms typer and facilitator.

Candidates

Candidates for typing to communicate include individuals who lack reliable pointing skills and who cannot speak or whose speech is extremely limited or disordered (e.g., limited to repetitive phrases, and speech that echoes what others around them have said or are saying); one current theory is that people with developmental disabilities often experience dyspraxia or difficulty with intentional action, including speech, initiation, and motor planning. Recent research, mostly coming from the field of neuroscience, on the connection between dyspraxia and difficulties with speech (Donnellan, Hill & Leary, 2013; Dziuk, et al., 2007; Mostofsky, Burgess, & Larsen, 2007) underscores the importance of considering a motoric base for challenges with speech. Further, it is becoming clear that development of improved motor planning and more organized intentional movement is possible with training and appropriate support (Torres, et al., 2013).

“As a child, I struggled with no reliable way to communicate. I now live out my dream of traveling to other states to educate others on movement and communication differences.  Primarily, I advocate to promote the Presumption of Competence.”

Tracy Thresher

Support

The typed communication with the multiple forms of support provided by the facilitator allows the typer to communicate messages that differ in their complexity and usefulness than the use of speech or unaided AAC alone. This support is highly individualized and based on specific needs, thus it does not look the same from person to person. For example, Luke receives support at the hand with strong backward pressure after each keystroke. Megan types with a light touch on the shoulder. Rebecca types with one hand. Shaffer works on developing a rhythm with two-handed typing. People who type to communicate successfully often use it as part of a total communication approach. It is used in combination with other methods of communication including speech, sign, gesture systems, etc. This enables the person access to the fullest range of communication options. (Breaking the Barriers, date)

Typing to communicate involves a facilitator, who can be a teacher, parent, speech pathologist, or friend, providing multiple methods of support to a communication aid user we refer to as a Typer. While facilitator support is dynamic and fluid, there are three main elements of support.

3 Core Elements of Support

Physical Support

Physical support may include the facilitator isolating the index finger, stabilizing the arm to overcome tremor; providing backward resistance on the arm to slow the pace of pointing or to overcome impulsiveness; touching the forearm, elbow, or shoulder to help the person initiate typing; or pulling back on the arm or wrist to help the person not strike a target repetitively.

Emotional Support

Emotional support involves providing encouragement and motivation as the person types or points to communicate. This is especially important as many Typers experience high levels of anxiety and challenges navigating their sensory environment. Emotional support also includes communicating respect and a presumption of competence.

Communicative Support

Communicative support can include various forms of prompts and cues that can assist the FC user to stay focused on the communication interaction, to provide feedback to the FC user on the content of their message, and to assist the FC user in clarifying unclear messages.

Frequently Asked Questions

Who does this approach work for?

Typing to communicate may be useful for some individuals who have limited or highly impaired speech and who cannot point reliably on their own. This may be due to impulsivity, regulation of movement, eye/hand coordination, difficulty with initiation, and sustainment of movement.

Does typing to communicate work for every person with disability that can’t communicate?

This method may not work for everyone, but it has proven successful for many people with cerebral palsy, autism and other developmental disabilities. Determinations of candidacy and appropriateness of the method need to be made on individual basis.

Is typing to communicate recommended if my child or student has some verbal speech (i.e. asks for bathroom, or says people’s names)?

Typing can broaden the communication of individuals that have limited verbal skills as well as make communication more reliable for individuals that have echolalia or repetitive speech. May students with some verbal speech are able to communicate more fully and with more sophistication when provided support.

If my child communicates through typing, should that be the only AAC or communication means to be used?

Typing to communicate can be used in conjunction with other communication methods (i.e. pointing to pictures, use of speech, etc.) This method should be part of a total communication approach that allows individuals the greatest access to meaningful communication in all settings.

How long until the person learns to type to communicate? And how long to will it take before they can type with no physical support?

Because each person is unique, learning to type is an individualized process. It may take a considerable time to achieve success – sometimes weeks or months. Independence depends also on the motor issues that the person faces, as well as emotional issues. While not all communication aid users will be able to type with no physical support, independent typing is the goal for all Typers and their families.

Can an individual with a disability who does not talk really interact and communicate?

It is important that individuals with disabilities be presumed competent and desirous of ways to communicate; success or failure will depend not only on the communication user but also on the educational and interactional opportunities he or she finds available. Potential facilitators should seek training during all stages of learning and using the method.

In what contexts can supported typing be used?

This method is used in schools, at home, in social places (e.g. mall, party, restaurant), wherever interactions occur. People can use supported typing to do homework, to participate in a discussion in a college class, to chat with friends in a restaurant, to write essays, poetry or books, to request something or to engage in conversations.

How do I know that it is the communicator typing the message and not the person providing the support?

For each individual who learns to type with physical support, it is crucial that the person learns means of demonstrating authorship. For example, by learning to pass messages, by learning to make multiple-choice selections without physical support, by speaking before and as typing, by typing without physical support, or through other available methods.

Are there resources to support the training process?

Of course! The Training Standards (2000) will help support teams develop and maintain best practices and technique. Though not a replacement for hands on training, this comprehensive document will help guide new support teams in establishing best practice and working towards independence. Other materials can be found in the Resources section of this site.

How is Typing to Communicate similar to and different from Rapid Prompting Method?

Typing to communicate shares many common characteristics with RPM. Both methods are built on a foundation of supporting movement. Both rely on prompting and different types of support to help an individual with complex communication needs point to a device or letter board. Both have the goal of independent communication and require systematic practice to work toward that end. One of the primary differences is that individuals using RPM often stay on letter board for much longer, while individuals trained in typing to communicate start on high tech devices or move to devices very quickly. Another difference is that more physical support may be provided initially in typing to communicate.

What kinds of AAC devices do people use when typing to communicate?

We get this question a lot! There is no specific device necessary for typing to communicate. People use a whole variety of high and low tech devices. Recently, the iPad has become the most popular device as it is highly flexible, portable, and cost effective when compared with other designated communication devices. The most important thing is finding a device that works for the individual.

“Very pleasing people understand. I say it best typing…..I want a chance. Typing is hard to do.  To type with me people need to decide I am smart and capable.”

Scott Floyd