A hyper simple communication board for intubated patients

Note: I am not a medical professional, just a neighbor trying to help in a crisis. This article does not make claims about medical outcomes. Views are my own.

Imagine going one month without speaking a single word. The tube inside your throat is keeping you alive. And silent.

I don’t know what it’s like in an ICU, but having to lie mostly helpless in a bed for a month without the ability to express yourself vocally sounds like a special kind of awful.

My wife (a voice therapist) heard this true story through her professional network. Contemplating this patient’s experience made us feel sick. So we decided to do something about it, even if it was small. We made this:

Intubation Communication Board (English/Spanish)

Since I’m an instructional designer & product nerd, I thought I’d document some of our thinking. This project is not evidence-based; just made with love one night after our kid was in bed. If you can see a way to make it better, we welcome your feedback! You’re also free to use, share, and remix it for any worthwhile purpose. Please share it with friends and family who are care providers, who are headed to the hospital, or who are intubated and can receive visitors.

The Problem

When you’re intubated, you can’t talk. The tube keeps you breathing but also keeps your vocal folds apart so you can’t produce speech.

When you can’t talk, you may not be able to express your needs with specificity, especially if you can’t write or type (which might be hard depending on your medical condition). This is isolating in any situation, but especially when you’re battling a scary disease.

Intubated patients are usually sedated much of the time, which means they have fewer and narrower windows of opportunity to express themselves while lucid.

From the American Speech Language Hearing Association:

Not only do people deserve to have their basic needs met, such as to communicate that they are in pain or request that a loved one is called, but patients may be more likely to have a serious adverse medical event if they cannot communicate with their health care providers.

Before we go further, let me be really clear that this problem is real, but discussing it is not a critique of frontline nurses, doctors, or other care providers. They are true heroes who have to focus on keeping people alive. We wanted to see if we could make something simple enough to boost communication without obstructing their life-saving work.

Assumptions

• Lots of printable AAC boards exist already. Most of them are much more robust. But in light of the story we heard, we wondered if there’s an unfilled niche for a very simple version specifically for strained ICUs.
• Frontline workers already have too many demands on their time. Any resource we offer has to incur near-zero overhead in both time and money.
• It must be mindlessly simple to print or copy for a care provider, staffer, volunteer, or loved one.
• It needs to be legible and intelligible to as many patients as possible, including people who may be sedated or lucid only intermittently.
• It should preserve as many pathways to communication as possible.
• Just to calibrate expectations, this resource will not replace rich communication and accompanying human connection. But if it offers a small and direct way to voice their needs and concerns, that’s still a win. It’s a small battle that might help them win the war.

Design Choices

• We chose one page, portrait, single-sided, black and white so it’s high contrast, it’s easy to read, and no information is lost when printed grayscale. It should work for almost anyone with a printer.
• We shared it as a public Google Doc so anyone can make a copy and revise it if they have different needs.
• We decided on 12 messages as a compromise between being easy to understand and offering broad message coverage.
• We knew we needed “Yes” and “No”, which we outlined with a very heavy box so they stand out for fast access. They are in the “gravity zone” at the bottom of the page on the right, which is hopefully the easiest place to reach for a right-handed patient.
• That left us 10 messages. We numbered them so patients can relay a message either by pointing to it or by holding up the corresponding number of fingers. This also means the first 5 should be the most important, since they can be signed with a single hand.
• We tried to order messages by our best guess for priority (a mix of urgency and frequency). Again, I’d emphasize that these choices are not evidence-based—they can be altered based on a patient’s specific needs.
• We constrained every message to fit on a single line. We included English and Spanish labels, since in our community these are the most frequent native languages.
• We also included a large icon to serve as a signpost and a backup help for people who can’t read the text.
• We added “Thank you” because we hope it will foster human connection, acknowledge that patients are more than their needs, and convey to care providers that we appreciate their heroic work.

Questions & Other Resources

Can I modify this board? Absolutely. If you’re logged in with your Google account you can choose File > Make a Copy and then revise to meet your needs.

You mentioned other AAC boards? There are many other, more complete options at these links with many languages available:

• https://aaccommunity.net/2020/03/covid-19-board/
• https://www.patientprovidercommunication.org/covid-19-free-tools.htm
• https://widgit-health.com/downloads/for-professionals.htm

What else does ASHA say about AAC during COVID-19 treatment?

• Please check out this article!

Voice therapy? Is that a real thing?

Yes! Think of it as physical therapy focused on the muscles you use to talk. It’s closely related to swallowing therapy and performed by licensed speech language pathologists (SLPs), typically under the medical supervision of an ENT. People may need it for all kinds of reasons, including stroke, traumatic brain injury, intubation, intensive professional use of the voice (e.g. singers and teachers), and other issues. It can dramatically improve quality of life for people who need it.

My family member or friend lost their voice after intubation. Is there hope for them?

Intubation can often damage the vocal folds, especially over long periods or in emergencies. Sometimes this damage heals on its own. In cases where it doesn’t, a voice therapist or ENT may be able to help.

Special thanks to my amazing wife who helped me organize and improve this post.