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What is Total Communication?

Total Communication uses a variety of methods to support conversation.


Did you know ...?

Only 7% of any message is conveyed through words! 38% is conveyed through certain vocal elements, and 55% through non-verbal elements (facial expressions, gestures, posture, etc.) There are many methods of communication which can be used to convey a message, such as:

  • Speech
  • Vocalisations (making non-speech sounds)/Tone of voice
  • Facial expression
  • Gesture
  • Drawing
  • Writing


Support Conversation

  • Have a pen and paper to hand
  • Write down important pieces of information
  • You do not need to write full sentences just key words
  • Avoid long sentences
  • Give written or picture choices so the person is able to point to what they need/want/are talking about
  • Use a calendar to aid orientation to day/month/year. Write down when visitors are due, when activities/tests are planned, etc.
  • Props like photographs and maps can also be useful as the person can point to them. The 'golden rule' of total communication is to try everything to get the message across, rather than just relying on speech. Be as inventive as you can and have fun
  • Do not expect perfect speech. Any means of communication should be accepted if it helps a person to communicate.

You can encourage and develop the use of these other communication methods through the following activities:


Encourage Gesture

  • If you haven't understood what someone has said ask them if they can show you what you do with it e.g. say 'show me'
  • Give examples using gesture e.g. raise your hand as if drinking or brushing your hair
  • Practise gestures by showing the person pictures of basic objects. See if they can communicate the item to you in a way that you could pick out that object from a group e.g. pen, cup, brush, spoon
  • Charade games are good for developing the use of gesture and mimes.


Encourage Writing

  • If the person can write, encourage them to do so. If their writing hand is now weak then exercises such as tracing over shapes, letters and words can help to improve pen control
  • Ensure the person always has a pencil and paper handy. Clip boards are also useful to provide a hard surface if the person is sitting in bed
  • Thick pens are easier to grip
  • Any writing ability should be encouraged. The first letter of a word can provide a valuable clue as to what the person is trying to communicate.


Encourage Drawing

  • Try drawing familiar objects
  • Take it in turns to draw something and the other person has to guess what you have drawn
  • If the person finds it difficult to draw, they can start by copying pictures you have drawn or do dot-to-dot pictures
  • Encourage the person to draw their response to questions. This may take some practise initially.


Facial expression

  • Pay close attention to the person's facial expression. They may be trying to tell you how they are feeling
  • Encourage them to use slightly exaggerated facial expression as this will make it easier to decipher.



  • Encourage the person to point to the things they want, rather than struggle to say the word
  • Some people may also find that pointing to charts with pictures on helps them to get their message across
  • Speak to your speech and language therapist about the possibility of introducing one of these charts. Be aware that they are not appropriate for everyone.


Activities during Visiting Time

Make sure that you have read the information leaflets and advice so that you understand your friend/relative's communication difficulties. Encourage everyone who visits to do the same. This way any visitors will understand and will feel more confident about what to do to help.

The following materials may be useful when visiting:

  • Family photographs (labelled photos are sometimes helpful)
  • Pen and paper (thicker pen/felt pen can sometimes be easier)
  • Pack of playing cards
  • Dominoes
  • Music to listen to
  • Magazines.



  • Sort them into suits / colours
  • Sequence them by number
  • Match pairs

Simple games include snap, patience and pairs.



Use a small number (e.g. 3 or 4) initially, taking turns to match numbers. Increase the number of dominoes as confidence and ability returns.



Use photographs as a focus for communication. Encourage your relative to show you who he/she wants to know about or tell you about. These can be developed into an album/chart.


Your Speech and Language Therapist may suggest further materials / activities to help.