[Autism and nursing. Facilitated communication: significance of and use to the nursing of persons with autism with severe disabilities of action and communication].

The following article searches for evidence based nursing measures in case of severe disabilities of action and communication, if criteria of autism can be applied. The effects of the impairments on daily life are described in typical situations. The caregivers of the persons affected must perform a constant and very demanding care, if they want to cope with daily life and strive for a meaningful social existence. The given situation prompted the question how professional caregivers take care of individuals with autism, who are both apraxic and aphasic. The central characteristics of autism are described on the basis of the International Classification of Diseases (ICD), and specific therapeutic interventions are named. But neither autism therapies nor a literature search concerning nursing concepts for apraxic and aphasic persons could answer the above question. Hence, the author investigates the nursing relevance of the pedagogical concept of Facilitated Communication (FC). That widespread but scientifically, controversially discussed method is applied to persons with autism who are apraxic and unable to speak and communicate with gestures or facial expressions. Practical examples of daily life give a first impression of the use of Facilitated Communication. Subsequently the historical development, the target group and central elements of Facilitated Communication, as communication assessment and well-directed physical, verbal and emotional support, are described. The depiction of the concept FC ends with the discussion regarding the validity of the method. If validity of Facilitated Communication is discussed the term apraxia is frequently mentioned. In order to better understand the nature of apraxic disorders and to validate Facilitated Communication more appropriately, this method is brought into relationship with knowledge of medicine and physiotherapy. Basic Stimulation and the concept of Affolter resemble Facilitated Communication. They focus similar target groups and work likewise with physical contact; therefore differences and equivalencies are discussed. Finally, the possible application of Facilitated Communication in nursing is presented in the context of the preceding investigations. The "Action Oriented Care" of Wittneben forms the frame to the exemplary development of a nursing assessment and description of nursing measures for persons with autism and severe disabilities of action and communication. A representation of relevant evaluation criteria permits the nurses to estimate the effectiveness of their care and gives thus reference points, whether the practiced care actually helps the persons who are affected.