The Kirkpatrick model provides one technique for appraisal of the evidence for any reported training program and could be used to evaluate whether a training program is likely to meet the needs and requirements of both the organisation implementing the training and the staff who will participate.

The results suggest a need for training nurses in the use of alternative modes of communication. Nurses also need access to a variety of simple augmentative communication devices for use with patients who are unable to speak. Finally, nurses should collaborate with speech pathologists on the development of preadmission information and bedside training for people who are admitted to hospital with severe communication impairment.

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Time is perceived by nurses as both an enemy and friend for improving communication. Nurses who perceive that communication takes too long may avoid communication and miss opportunities to improve communication through increased familiarity with the person's communication methods. Those who take time to communicate narrate applying a range of strategies to achieve success in basic needs communication.

A total of 279 adults with cerebral palsy from across Australia responded to a survey which sought information about their health, modes of communication, access to information and perception of their own ageing process. Results indicated that 77% of the respondents believed that their physical condition was changing and 78% were taking medication. All but 11% indicated that the ageing process was having some effect on their lifestyle. A total of 22% had made retirement plans. Respondents discussed their health concerns with their family or attendants and 57% judged their general practitioner knowledgeable about cerebral palsy. The implications of the results for future service planning and delivery are considered.Although little is known about the life expectancy and ageing process of adults with cerebral palsy (Janicki, 1989; Pellegrino, 1995; Turk, Overeynder, & Janicki, t995), there has been some suggestion that the number of adults with cerebral palsy might be growing due to advances in medical care, particularly gastrostomy feeding, antibiotic treatment, and better management of respiratory infections, coupled with an increase in life expectancy for adults overall (Crichton, Mackinnon, & White, 1995; Murphy, Molnar, & Lankasky, 1995). Crichton et al. (1995) noted that the overall survival rate at 30 years of the 3,187 cases in their study was at least 87%, while Turk et al. (1995) concluded that most adults with cerebral palsy were generally healthy and could remain so as they aged if given better access to preventative health practices. However, Janicki (1989) noted that there is little clinical information on individuals with cerebral palsy who are ageing.In a study of 883 individuals with cerebral palsy and an intellectual disability aged 45 years and over, Janicki (1989) concluded that the life expectancy of individuals with severe cerebral palsy is less than that of individuals with intellectual disability or conditions other than those involving severe motor impairments. Kailes (1993) supported Janicki's (1989) observation that there was little information on individuals with cerebral palsy who were ageing. She also noted that there was little knowledge among health professionals on the issues faced by such individuals. Kailes (1993) reported that she had searched long and hard to find a medical practitioner who specialised in adults who had cerebral palsy. Anecdotal information concerning ageing with cerebral palsy has suggested that individuals with cerebral palsy are experiencing changes in their levels of fitness and ability which are both unexpected and unwelcome (Barrett, 1993;Kailes, 1993;Schwartz, 1994 ;Williams, 1993). Indeed, adults with cerebral palsy and those who deliver services to this population have both expressed some concern that individuals with cerebral palsy may experience negative effects of the ageing process earlier than nondisabled individuals (Barrett, 1993;Kailes, 1993;Turk et al., 1995). The results of a study of the medical and functional status of 101 adults with cereb...

Many adults with cerebral palsy and complex communication needs rely upon the support of their unpaid carers when they are in hospital. In this paper, the authors present some of the findings of a larger qualitative study of the experiences of unpaid carers of hospitalized adults with cerebral palsy and complex communication needs who did not have access to their usual augmentative and alternative communication (AAC) systems. Drawing upon the stories of unpaid carers, communication issues associated with cerebral palsy and complex communication needs and the absence of AAC are discussed. Such information can be used to assist AAC specialists, hospital staff, and hospital policy developers to improve care provided to not only people with cerebral palsy and complex communication needs, but also to other people who are unable to speak in hospital.

The results demonstrate that participation in mainstream community groups with support from trained mentors is a viable option for developing a retirement lifestyle for older individuals with disability.

Poor patient–provider communication in hospital continues to be cited as a possible causal factor in preventable adverse events for patients with severe communication disabilities. Yet to date there are no reports of empirical interventions that investigate or demonstrate an improvement in communication in hospital for these patients. The aim of this review was to synthesize the findings of research into communication in hospital for people with severe communication disabilities arising from lifelong and acquired stable conditions including cerebral palsy, autism, intellectual disability, aphasia following stroke, but excluding progressive conditions and those solely related to sensory impairments of hearing or vision. Results revealed six core strategies suggested to improve communication in hospital: (a) develop services, systems, and policies that support improved communication, (b) devote enough time to communication, (c) ensure adequate access to communication tools (nurse call systems and communication aids), (d) access personally held written health information, (e) collaborate effectively with carers, spouses, and parents, and (f) increase the communicative competence of hospital staff. Currently there are no reports that trial or validate any of these strategies specifically in hospital settings. Observational and evaluative research is needed to investigate the ecological validity of strategies proposed to improve communication.