Might I strongly suggest adopting the following protocol on the provision of backward resistant physical support for pointing (my preferred, descriptive name for "facilitation") as a treatment approach: (LINK to download a slideshow version)
- When support is provided anywhere below the elbow (such as forearm, wrist or hand), ONLY rely on the client's responses to predictable questions (e.g., with a known answer or multi-choice) - even if you believe they have more to say. Work on fading support before relying on generative responses.
- Then, only when support is faded to the elbow, can we rely on the responses of clients when they share their original ideas and answer open-ended questions (e.g., What did you do last night? What's your favorite movie? Is there anything you want to say?)
- Help the client learn to move more independently; try to move support from hand, to wrist, to forearm, to elbow EVERY time you practice pointing/typing.
- Always include more than one 'facilitator' in the training process. Individuals that show potential for pointing with backward resistant support MUST be able to do so with more than just their therapist or teacher. It is our responsibility to include no fewer than one other facilitator in any client's life. This might be a parent, caregiver, sibling, aide or related professional.
- Teach your communicators who require that they MUST learn to point/type with more than one 'facilitator,' or else listeners cannot rely on their messages.
- Share with your client that independence (i.e., no physical support) and pointing/typing with multiple 'facilitators' is the goal.
- It's the ethical thing to do!