bluuebunny/crossref_metadata_2025 huggingface dataset:
The Tool for Understanding Residents’ Needs as Individual Persons (TURNIP): construction and initial testing
Authors: Edvardsson David , Fetherstonhaugh Deirdre , Nay Rhonda
Published: April 2011

Aims and objectives.  To construct and evaluate an intervention tool for increasing the person‐centredness of care in residential aged care services.

Background.  Providing care that is person‐centred and evidence‐based is increasingly being regarded as synonymous with best quality aged care. However, consensus about how person‐centred care should be defined, operationalised and implemented has not yet been reached.

Design.  Literature reviews, expert consultation (n = 22) and stakeholder interviews (n = 67) were undertaken to develop the Tool for Understanding Residents’ Needs as Individual Persons (TURNIP).

Methods.  Statistical estimates of validity and reliability were employed to evaluate the tool in an Australian convenience sample of aged care staff (n = 220).

Results.  The 39 item TURNIP conceptualised person‐centred care into five dimensions: (1) the care environment, (2) staff members’ attitudes towards dementia, (3) staff members’ knowledge about dementia, (4) the care organisation and (5) the content of care provided. Psychometric testing indicated satisfactory validity and reliability, as shown for example in a total Cronbach’s alpha of 0·89.

Conclusions.  The TURNIP adds to current literature on person‐centred care by presenting a rigorously developed intervention tool based on an explicit conceptual structure that can inform the design, employment and communication of clinical interventions aiming to promote person‐centred care.

Relevance to clinical practice.  The TURNIP contains clinically relevant items that are ready to be applied in clinical aged care. The tool can be used as a base for clinical interventions applying discussions in aged care organisations about the quality of current care and how to increase person‐centredness of the care provided.
Absence of nucleoid occlusion effector Noc impairs formation of orthogonal FtsZ rings during Staphylococcus aureus cell division
Authors: Veiga Helena , Jorge Ana M. , Pinho Mariana G.
Published: April 2011

The Gram‐positive pathogen Staphylococcus aureus divides by synthesizing the septum in three orthogonal planes over three consecutive division cycles. This process has to be tightly coordinated with chromosome segregation to avoid bisection of the nucleoid by the septum. Here we show that deletion of the nucleoid occlusion effector Noc in S. aureus results in the formation of Z‐rings over the nucleoid, as well as in DNA breaks, indicating that Noc has an important role as an antiguillotine checkpoint that prevents septa from forming over the DNA. Furthermore, Noc deleted cells show multiple Z‐rings which are no longer placed in perpendicular planes. We propose that the axis of chromosome segregation has a role in determining the placement of the division septum. This is achieved via the action of Noc which restricts the placement of the division septum to one of an infinite number of potential division planes that exist in S. aureus.
New insights into riboswitch regulation mechanisms
Authors: Bastet Laurène , Dubé Audrey , Massé Eric , Lafontaine Daniel A.
Published: April 2011

Riboswitches are genetic elements located in non‐coding regions of some messenger RNAs (mRNAs) that are present in all three domains of life. The binding of ligands to riboswitches induces conformational changes in the mRNA molecule, resulting in modulation of gene transcription, or RNA splicing, translation or stability. This mechanism of regulation is particularly widespread in bacteria and allows a direct response to various metabolic changes. A large number of riboswitches have been discovered in the last few years, suggesting the existence of a huge diversity of regulatory ligands and genetic mechanisms of regulation. This review focuses on recent discoveries in riboswitch regulatory mechanisms as well as current outstanding challenges.
Dissecting the complete lipoprotein biogenesis pathway in Streptomyces scabies
Authors: Widdick David A. , Hicks Matthew G. , Thompson Benjamin J. , Tschumi Andreas , Chandra Govind , Sutcliffe Iain C. , Brülle Juliane K. , Sander Peter , Palmer Tracy , Hutchings Matthew I.
Published: April 2011

Following translocation, bacterial lipoproteins are lipidated by lipoprotein diacylglycerol transferase (Lgt) and cleaved of their signal peptides by lipoprotein signal peptidase (Lsp). In Gram‐negative bacteria and mycobacteria, lipoproteins are further lipidated by lipoprotein N‐acyl transferase (Lnt), to give triacylated lipoproteins. Streptomyces are unusual amongst Gram‐positive bacteria because they export large numbers of lipoproteins via the twin arginine protein transport (Tat) pathway. Furthermore, some Streptomyces species encode two Lgt homologues and all Streptomyces species encode two homologues of Lnt. Here we characterize lipoprotein biogenesis in the plant pathogen Streptomyces scabies and report that lgt and lsp mutants are defective in growth and development while only moderately affected in virulence. Lipoproteins are lost from the membrane in an S. scabies lgt mutant but restored by expression of Streptomyces coelicolor lgt1 or lgt2 confirming that both encode functional Lgt enzymes. Furthermore, lipoproteins are N‐acylated in Streptomyces with efficient N‐acylation dependent on Lnt1 and Lnt2. However, deletion of lnt1 and lnt2 has no effect on growth, development or virulence. We thus present a detailed study of lipoprotein biogenesis in Streptomyces, the first study of Lnt function in a monoderm bacterium and the first study of bacterial lipoproteins as virulence factors in a plant pathogen.
ZmMKK4, a novel group C mitogen‐activated protein kinase kinase in maize (Zea mays), confers salt and cold tolerance in transgenic Arabidopsis
Authors: KONG XIANGPEI , PAN JIAOWEN , ZHANG MAOYING , XING XIN , ZHOU YAN , LIU YANG , LI DAPENG , LI DEQUAN
Published: April 2011

Mitogen‐activated protein kinase (MAPK) cascades are signalling modules that transduce extracellular signalling to a range of cellular responses. Plant MAPK cascades have been implicated in development and stress response. In this study, we isolated a novel group C MAPKK gene, ZmMKK4, from maize. Northern blotting analysis revealed that the ZmMKK4 transcript expression was up‐regulated by cold, high salt and exogenous H2O2, but down‐regulated by exogenous abscisic acid (ABA). Over‐expression of ZmMKK4 in Arabidopsis conferred tolerance to cold and salt stresses by increased germination rate, lateral root numbers, plant survival rate, chlorophyll, proline and soluble sugar contents, and antioxidant enzyme [peroxidase (POD), catalase (CAT)] activities compared with control plants. Furthermore, ZmMKK4 enhanced a 37 kDa kinase activity after cold and salt stresses. RT‐PCR analysis revealed that the transcript levels of stress‐responsive transcription factors and functional genes were higher in ZmMKK4‐over‐expressing plants than in control plants. In addition, ZmMKK4 protein is localized in the nucleus. Taken together, these results indicate that ZmMKK4 is a positive regulator of salt and cold tolerance in plants.
Auxin modulates the enhanced development of root hairs in Arabidopsis thaliana (L.) Heynh. under elevated CO2
Authors: NIU YAOFANG , JIN CHONGWEI , JIN GULEI , ZHOU QINGYAN , LIN XIANYONG , TANG CAIXIAN , ZHANG YONGSONG
Published: April 2011

Root hairs may play a critical role in nutrient acquisition of plants grown under elevated CO2. This study investigated how elevated CO2 enhanced the development of root hairs in Arabidopsis thaliana (L.) Heynh. The plants under elevated CO2 (800 µL L−1) had denser and longer root hairs, and more H‐positioned cells in root epidermis than those under ambient CO2 (350 µL L−1). The elevated CO2 increased auxin production in roots. Under elevated CO2, application of either 1‐naphthoxyacetic acid (1‐NOA) or N‐1‐naphthylphthalamic acid (NPA) blocked the enhanced development of root hairs. The opposite was true when the plants under ambient CO2 were treated with 1‐naphthylacetic acid (NAA), an auxin analogue. Furthermore, the elevated CO2 did not enhance the development of root hairs in auxin‐response mutants, axr1‐3, and auxin‐transporter mutants, axr4‐1, aux1‐7 and pin1‐1. Both elevated CO2 and NAA application increased expressions of caprice, triptychon and rho‐related protein from plants 2, and decreased expressions of werewolf, GLABRA2, GLABRA3 and the transparent testa glabra 1, genes related to root‐hair development, while 1‐NOA and NPA application had an opposite effect. Our study suggests that elevated CO2 enhanced the development of root hairs in Arabidopsis via the well‐characterized auxin signalling and transport that modulate the initiation of root hairs and the expression of its specific genes.
Intermittent preventive treatment of malaria in pregnancy: at the crossroads of public health policy
Authors: Chico R. Matthew , Chandramohan Daniel
Published: April 2011

The intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine‐pyrimethamine (SP) has been a key component of the focused antenatal care package for nearly a decade, reducing the burden of low birthweight attributable to malaria in sub‐Saharan Africa. However, SP has lost parasite sensitivity in many sub‐Saharan locations during the same period, rendering its beneficial effect in IPTp debatable. Malaria transmission has also declined in some epidemiological settings. There is no evidence to suggest, however, that the risk of malaria in pregnancy without preventive measures has declined in the same locations. Thus, the urgency to identify efficacious drugs and/or new strategies to prevent malaria in pregnancy remains as great as ever. We summarise the results of recently published SP‐IPTp studies from areas of high drug resistance and/or low malaria transmission. We also present the evidence for mefloquine and azithromycin‐based combinations (ABCs), two leading drug options to replace SP in IPTp. We discuss optimal dosing for ABCs and their likely protection against several sexually transmitted and reproductive tract infections. We also summarise data from a diagnosis‐based alternative to IPTp known as the intermittent screening and treatment (IST) for malaria. Clinical and operational research is urgently needed to compare birth outcomes achieved by IPTp with ABCs vs. IST using an efficacious antimalarial therapy.
Internship — a unique postgraduate training programme in speech and language therapy
Authors: ROBINSON H FIONA , PATERSON JO
Published: April 2011

ABSTRACT  Clinical experience of the management and rehabilitation of the patient with voice disorders and problems associated with head and neck cancer is limited for speech and language therapists with a mixed caseload. These generalist therapists are expected to cope confidently and effectively and to offer assessment, differential diagnosis and therapeutic intervention to the highest standards, often without the support of a specialist speech and language therapist. The Royal College of Speech and Language Therapists requires that to become a specialist ENT speech and language therapist, the training should include a period of work experience fully supervised by a specialist voice therapist (Royal College of Speech and Language Therapists, 1991). It is the experience of the author (HFR) (as an Advisor to the College) that in many districts, therapists do not have access to this degree of supervision and clinical exposure. The internship is a simple innovative approach to the training of qualified speech and language therapists in the UK and may be defined as ‘a reciprocal approach, which provides clinical training to a qualified therapist in return for an equal amount of time managing an autonomous ENT caseload'. The training is a unique postgraduate learning process, primarily because it has been individually tailored and is student‐centred. The host department — Nottingham — provides the learning and training opportunities, with exposure to a wide range of clinical experiences. There are no fees for training, although interns need to be aware of the hidden costs, for example, travelling expenses and accommodation (usually met by the intern) and the provision of caseload cover at the intern's home servie. There have been four placements since the call for applicants in the summer of 1993. This project won the Education Section of the Arjo/Therapy Weekly 1994 Awards, and won the overall Best Winner prize.
Negotiating services for special schools
Authors: KEE MIRIAM , ROBINSON KATH
Published: April 2011

ABSTRACT  (1) Brief description of the historical method of allocating services to special schools, usually based on the numbers of children in schools/statemented children; (2) Difficulties with this — examination of the reasons for therapists feeling frustrated and being difficult to recruit; (3) Description of the system of staff allocation, based on the communication need within the school. Discussion of services, based on functional communication rather than skills development. Discussion of a therapy model using ratio of assistants, parental involvement, integration into the curriculum and an effectiveness measure by use of outcome measurement system; (4) The effectiveness measure is then used as the basis for negotiation with head teachers, the Local Education Authority and District Health Authority for the amount of therapy provided in individual schools.
Speech and language therapy for adults with special needs
Authors: VENDITOZZI MARIA
Published: April 2011

ABSTRACT  This paper reports on recent developments which took place at Hazeldene Work Resource Centre, Kilwinning, Scotland, in relation to the provision of speech and language therapy. The necessity to utilise limited resources in the most efficient manner required a change of focus at the Centre. In the past, provision of speech and language therapy services was limited to individual client‐based therapy, but now the re‐evaluation and reorganisation of service provision was considerd to be necessary. The staff at the Hazeldene Centre were keen to cooperate in an exploration of how best to improve the direct and indrect delivery of service. It was believed that the knowledge and skills of the speech and language therapist could contribute to the overall assessment of clients and thus the success of their educational and work placements would improve. Speech and language therapists have an in‐depth understanding of language and communication, knowledge of how and where it breaks down, and how to capitalise on existing skills. It was felt that these skills could contribute to the assessment package already in use at the Centre (see Appendix I) to help staff to reach informed decisions about a client's future.
Investigating speech processing skills in young children
Authors: VANCE MAGGIE
Published: April 2011

ABSTRACT  This paper stresses the need to refer to normal control data when assessing children with speech disorders. It is based on the findings of a completed, one‐year, full‐time research project designed to investigate the normal development of speech, auditory and rhyme skills within a psycholinguistic framework (Stackhouse & Wells, 1993). The aim of the project was to examine phonological processing skills in normally developing children for comparison with children presenting with speech, lexical and literacy disorders. A range of tasks was presented to 100 normally developing children, aged 3–7 years. The tasks included auditory discrimination, rhyme judgement, detection and production; speech repetition, naming and continuous speech. The tasks were presented in both visual and auditory modalities, and both real and non‐word stimuli were used. For each set of tasks stimuli were identical or closely matched, using phonetic criteria. Data was analysed for subjects within each age band, i.e. 3‐year‐olds, 4‐year‐olds, 5‐year‐olds, 6‐year‐olds and 7‐year‐olds. Analysis of variance revealed significant effects of age on all tasks. Comparisons were made of performance across the different presentations and stimuli‐type relevant to each task and significant effects of presentation and stimuli‐type were found for some tasks but not for all comparisons made. These findings allowed us to present a profile of normal development in performance across a range of input and output processing tasks. The time constraint prevents the full profile of results being included. However, the implications of the results for clinical practice will be presented. For example, given that normally developing children find non‐word repetition more difficult than real‐word repetition, at what point is the difference in performance on these tasks indicative of a motor programming deficit? Further, given the relationship between rhyme detection and production skills in normally developing children, at what age is the failure to produce any rhyming words significant? In summary, this study identified typical developmental profiles of phonological processing skills in children of 3–7 years of age. Speech and language therapists can use these results to identify with greater accuracy children with speech and language difficulties who may present with atypical psycholinguistic profiles. Subsequent therapy can be targeted in a more precise way.
Children with severe learning disabilities
Authors: KERSNER MYRA , WRIGHT JANNET A
Published: April 2011

ABSTRACT  In a study by Wright (1994) it was found that successful collaboration between speech and language therapists and teachers had implications for the delivery of services for children with communication problems. Different approaches to working together were indicated and patterns of collaborative working practices were identified in relation to assessment and intervention. The current research was designed in order to investigate the patterns of collaboration between therapists and teachers working together with children with severe learning disabilities (SLD); to establish whether these were influenced by the fact that in this area of work it may be possible to define a specialist (or a specialised) teacher and/or therapist by virtue of experience or qualifications; to investigate the approaches taken by these professionals, and to identify possible implications for service delivery to the specific client group. One hundred and sixty questionnaires, comprising open as well as closed questions, were sent to speech and language therapists and teachers who work with children with SLD. They were distributed over a wide geographical area to specialist/non‐specialist pairings of therapists and teachers. There was a return rate of 61%. The responses were analysed by use of quantitative as well as qualitative methodology, qualitative methodology being appropriate given the sensitive nature of the topic under investigation (Walker, 1985). Despite the external pressures from legislative changes in health and education, the professionals working in SLD settings showed a high incidence of collaborative working practices. This was particularly noticeable in the areas of assessment, planning and intervention. Over 50% of the respondents reported that they carried out joint assessments and more than 75% shared planning and intervention. This is a higher incidence than that shown in the study of Wright (1994). The ways in which teachers and therapists worked together showed considerable variety, ranging from running joint Makaton, Derbyshire workshops and social skills sessions, to planning modifications to the curriculum. The involvement of other adults, such as non‐teaching assistants, in these activities was also apparent from the data. These findings have implications for the ways in which speech and language therapists organise and manage their time in SLD schools. A collaborative approach offers alternative ways of working with the children, thus enabling therapists to extend the potential of their service delivery whilst maintaining an holistic approach to each child.
Collaborative working in the development of a school‐based speech and language therapy service
Authors: SHAW LIZ , LUSCOMBE MARIA , OSTIME JANET
Published: April 2011

ABSTRACT  School‐based speech and language therapy for children with special needs attending mainstream school is becoming a more common mode of service delivery. This paper describes how a model of service for school‐based working was planned, developed and implemented in consultation with the Local Education Authority (LEA), Health Authority Purchasers, parents and other professionals. The paper is divided into three parts to reflect different aspects of the service development process. Part I explores the consultation and planning process involved in developing the initial model of service and the audit of the early stages of service implementation. The results of the audit and their implications for the service are discussed. Part II describes the planning, implementation and evaluation of a teacher training programme developed as an integral part of the service. Part III outlines the collaborative process involved in refining referral criteria. The paper emphasises the value of collaborative working with both the Education Services and parents in the development of such a therapy service.
Bridging the gap: listener perceptions and linguistic measures in head‐injured narrative
Authors: BODY RICHARD , PERKINS MICK
Published: April 2011

ABSTRACT  The last decade has seen a marked increase in the number of studies investigating the discourse skills of people who have sustained closed head injury (CHI). The results of these studies have been mixed, which arises in part from the diversity of linguistic measures that have been employed. In addition, the clinical applicability of many of these measures is very limited. This study aims to establish linguistic measures for analysing narrative tasks with this client group which are clinically practical and which reflect listeners' perceptions of communicative performance. The study investigated the narrative re‐telling skills of 20 head‐injured subjects and 20 controls by use of an eight‐minute audiotaped story taken from a popular magazine. The control subjects were selected from other families in which someone had sustained a head injury and were matched for age, sex and education. In particular, the study focused on the relationship between qualitative ratings of the story transcripts and formal linguistic analyses. The ratings, on scales of organisation and context, were carried out by five members of Headway (the head injury support group) and five speech and language therapists. A subset of ‘best’ and ‘worst’ transcripts (which included overlap between CHI and control subjects) was used to isolate corresponding linguistic measures, which were then tested on all the transcripts. The results of the qualitative ratings and linguistic analyses will be presented.
Closing the circle: from research to clinical service
Authors: WALKER SANDRA , CAIRD F I , GILHOOLY M
Published: April 2011

ABSTRACT  Carers of people with dementia report communication as a problem in day‐to‐day living. This study aimed to recruit 21 pairs of Alzheimer's disease suffererers and their carers from various community sources, but of 52 patients referred only a total of 15 pairs completed the whole six months of the study. Carers were randomly allocated to one of two intervention groups and a control group. One intervention group was offered general information on a range of functions, for example, memory, attention and communication, with key words and explanations aimed at modifying them. The other group was given an individual structured session focused directly on all aspects of communication, but with particular attention, both to the individual suffer's problems of communication and to indicators for management of communication. These indicators were based on tested tasks and on evaluations of the responsiveness of sufferers to techniques which facilitated performance, such as semantic and/or contextual cueing. The third group, acting as controls, were assessed at referral and at the end of the six months' study period only. No specific information of either type was made available to carers in this group during the period. The small numbers make the conclusions tentative. However, intervention appeared to influence carers to the extent that, overall, they perceived communication impairment as less of a problem in spite of a general deterioration of the patient's communication performance. Providing information to caregivers of both a general and a specific nature may have influenced the communication of some sufferers. This preliminary study suggests that speech therapy can made a contribution to the quality of life for elderly patients with dementia and their carers. As a result, the Victoria Infirmary NHS Trust now offers a full clinical assessment and management service for carers and patients reporting memory‐related communication difficulties.
Laterality and rehabilitation: a comparison of linguistic and motoric function in two aphasic agraphic hemiplegic patients
Authors: PAPATHANASIOU ILIAS , WHURR RENATA , LORCH MARJORIE
Published: April 2011

ABSTRACT  Traditionally, in clincial practice, speech and language therapists train hemiplegic aphasic patients to write with the non‐dominant left hand. This study examines the side differences of the graphomotor and linguistic aspects of writing in two cases of agraphic aphasic hemiplegic patients. In one case writing was performed with the right hemiplegic hand, facilitated with a writing prosthesis which enabled functional recovery of the arm. In the other case, writing was performed with the left non‐dominant, non‐paralysed hand. The two moderate aphasic clients received four weeks of training to learn to use the prosthesis, followed by 12 weeks of treatment. Assessment took place before the training and at the end of the treatment period. Initially, writing performance was examined only with the left hand due to the lack of graphomotor skills and by both hands at the end of the trial. The results demonstrated that writing performance with the right hemiplegic hand, in conjunction with the prosthesis, was superior to the left hand in both cases. However, improvement in the other aspects of language, generalisation of language function as well as functional use of the hemiplegic hand in non‐clinical settings were observed only in the patient who used his right paralysed hand, facilitated with the prosthesis during the treatment period. The results suggest that this group of clients will benefit from the use of a writing prosthesis during the treatment period. This raises questions about the clinical strategies which speech and language therapists are using during the rehabilitation of writing.
Receiving the diagnosis of motor neurone disease
Authors: McCLENAHAN ROSHAN , JOHNSTON MARIE , EARLL LOUISE
Published: April 2011

ABSTRACT  It has been asserted that the impact of illness can best be understood in terms of the perception of the patient (identity of the illness, cause, time‐line, consequence and cure) rather than the disability resulting from the disease. This study was set up to examine patients' perceptions of illness before and after diagnosis and to assess, firstly, whether their perceptions determined the emotional impact of the diagnosis and, secondly, the coping strategies employed to cope with the diagnosis. This was a longitudinal study of 38 patients with suspected motor neurone disease (MND), seen before and after diagnosis in three centres in the UK, using standardised measures and theoretically derived questions. The standardised measures included disability rating scales and tests of emotional outcome. Patients' perceptions: identity. The mean number of symptoms did not alter before and after diagnosis. About 20% of patients identified their illness as MND before going to hospital for investigations; their anxiety and depression decreased after diagnosis, presumably as a result of being ‘prepared’. As expected, significantly more subjects (64%, Sign test, p = 0.0018) gave the MND label after diagnosis. For these people, anxiety and depression increased after diagnosis. Most saw something positive in getting the diagnosis. Patients who did not have the correct label before diagnosis became significantly more disabled over time. Patients' perceptions: cause. About half the subjects attributed their MND to a cause, even though there is no accepted cause of MND. They had significantly higher wellbeing scores; of these about 40% attributed it to their own behaviour and were found to be significantly less disabled (t = 2.84, df = 16, p = 0.012). Patients' perceptions: time‐line and cure. Before the diagnosis, only 24% of patients expected a cure, 24% expected to be better, and 26% expected to be worse. After diagnosis, 20% still expected a cure but none expected to be better. No significant relationship was found with severity of disability. Patients' perceptions: consequences. At both times, patients ranked their illness as being serious. This was not related to the severity of disability. In this study most of the subjects took coping action. This was associated with a reduction in anxiety and depression. It is important to note that seeking alternative remedies was associated with anxiety. This study has important implications for managing patients with MND.
Exploring interdisciplinary management of Parkinson's disease
Authors: NESBITT RUTH , THOMPSON ROBERT
Published: April 2011

ABSTRACT  Speech and/or swallowing impairment occurs in a high percentage of patients with Parkinson's disease. Mutch et al. (1986) report that in a study of 249 Parkinson's disease patients, 65% had speech difficulty and 18.5% of 265 Parkinson's disease patients surveyed reported swallowing impairment. The benefits of speech and language therapy for these patients have been recognised. Clearly, these patients can only benefit if they can access a speech and language therapy service. This pilot interdisciplinary project, between a speech and language therapy service and a general practice unit, set out to audit access to and awareness of the speech and language therapy service for patients with Parkinson's disease in a primary care setting. All the Parkinson's disease patients in one general practice unit were identified and invited to a speech and language therapy assessment. A survey of these patients and their carers was completed by interview investigating their awareness of their communication/swallowing difficulties and perceived need for speech and language therapy. A postal survey of all general practitioners in the Trust area was carried, out examining attitudes and past practice of general practitioners concerning referral of adult patients to the speech and language therapy service. Past referrals of Parkinson's disease patients to the service were analysed to establish historic access routes to the service. Speech and language therapy assessment and patient interviews were completed for 13 Parksinson's disease patients. Interviews were carried out with 10 carers. Questionnaires were sent to 69 general practitioners and 37 responses (54%) were received. Results of the general practitioner survey indicated poor awareness of the role of speech and language therapy for this client group. Patient and carer survey findings highlighted accurate perceptions regarding patient dysarthria symptoms. Speech and language assessment identified four of 13 patients requiring direct therapy and a further eight patients who could benefit from advice and information. Only one patient had no dysarthria symptoms. Referral analysis indicated that of 18 patients referred with Parkinson's disease to speech and language therapy, one had been referred by a general practitioner. The findings highlight the need for increased awareness among patients, carers and members of the primary healthcare team about the role of speech and language therapy with this client group, in order to ensure timely and appropriate referral. The outcome of this interdisciplinary audit project indicates benefits for patients, carers and general practitioners through improved identification of need and mutual education. The aims, process and issues involved in interdisciplinary audit of this kind are described, along with guidelines for the selection of suitable interdisciplinary audit topics.
Dysarthria in multiple system atrophy
Authors: GARRATT HELEN , WENNING GREGOR , QUINN NIALL
Published: April 2011

ABSTRACT  Multiple system atrophy (MSA) is a degenerative neurological condition involving multiple areas of the nervous system. This may result in combinations of parkinsonism, cerebellar, pyramidal and autonomic symptoms. Early in the course of the disease patients may present with similar symptoms to patients with idiopathic Parkinson's disease (IPD) and, in the past, this has led to people being diagnosed incorrectly as having IPD. The type of dysarthria present in MSA may be spastic, hypokinetic or cerebellar, or any combination of these, depending on the site of neurological damage. The literature has commented on the laryngeal element in the dysarthria, noting the early presentation of phonatory disorders and the greater impairment of laryngeal features when compared to IPD subjects. This study was undertaken to examine the dysarthria in MSA and, in particular, its phonatory component. Six subjects with MSA were entered into the study. Five presented with striatonigral degeneration (predominant Parkinsonian features) and one with olivopontocerebellar atrophy (predominant cerebellar features). Following the initial study the data were compared with three matched subjects with IPD. The subjects' speech was assessed by use of the Frenchay Dysarthria Assessment (FDA) and the Laryngograph PCLX systems. The dysarthria of these subjects was described as slurred, hypophonic and hoarse. Examination of the results of ‘all subject’ data from the FDA indicated that laryngeal function was the most impaired parameter. Results of the PCLX analysis shed more light on the nature of this laryngeal impairment. The Dx plot showed irregularities at low and high frequencies. Dx plots for IPD subjects reading the same passage showed much less low‐ and high‐frequency irregularity. This equates with the perceived nature of the phonatory disturbances in IPD as hypophonic but without hoarseness in the MSA subjects. The study confirms previous findings of a noticeable phonatory element of the dysarthria in MSA and also provides some further description of this in the results of the PCLX analysis. This finding should be further investigated and may provide additional information helpful in the diagnosis of MSA and its dysarthria.
Dysphagia in the elderly: a learning experience for those new to this field
Authors: SIDDALL PAULINE M. , GRIFFITHS JACKIE M.
Published: April 2011

ABSTRACT  A service review was undertaken at a recently opened 163‐bed hospital for acute care of the elderly (aged 65+) against a background of changing roles with dysphagia patients, a perceived increase of ‘swallow’ referrals, and multidisciplinary concern as to their management. The review showed that 73% of referrals followed a cerebrovascular accident (CVA) and, as a result, a project was set up with the Dietetics Department to develop an integrated and comprehensive service for the diagnosis, referral and management of elderly stroke patients with dysphagia. This was funded by the South West Regional Health Authority Audit Group.
Implications of using a vocabulary test standardised on monoglots, with dual‐language children
Authors: ABUDARHAM SAMUEL
Published: April 2011

ABSTRACT  Abudarham (1987) has advocated the use of the conceptual vocabulary (CV) (Swain, 1972) when assessing the vocabulary of dual‐language (DL) subjects. CV refers to the ability to name referents in either language. It is thus, a measure of ‘naming power’ rather than vocabulary in L1 and/or L2. A DL subject may respond correctly to 40 test stimuli in a ‘bilingual’ test. However, these may refer to only 20 referents known in both languages. On the other hand, 30 correct responses in only one language may relate to 30 different referents. The former's CV would be 20 and that of the latter, despite an ‘inferior’ vocabulary, would be 30. Using CV as a measure of language ability at a lexical level could help in the differential diagnosis between an L2 or a specific language‐learning problem. The response to the first 75 items of the British Picture Vocabulary Scales (BPVS) (Dunn et al., 1982) by 392 DL (Spanish/English) Gibraltarian children, aged 4–12 years, were analysed. Each item was presented in both languages. The raw scores for L1, L2 and CV were converted to standard scores (SSs) (see the BPVS manual (Dunn et al., 1982)). Although this could be justified for responses in English (Abudarham, 1995), there is little psychometric justification for doing so for performance in L1 (Spanish) or CV. However, as Genesee (1989) points out, ‘the purpose of this type of examination is not to prove the hypothesis that DL children's lexical development (L1, L2, CV) is comparable to their monoglot peers’, since the available data are not considered to be adequate, but rather to establish tenability'. A SS of more than 85 was obtained in English by children up to the age of 4;11 and in Spanish by children up to the age of 5;5. Depending on the language tested, all children above these respective ages could be considered as having a language problem and be referred for language therapy. Given that all these subjects were considered to have no learning or language disability, the results give alarming warnings regarding the use of language tests standardised on monoglots, with DL children. When, however, the SSs for CV were calculated, subjects up to the age of 7;5 were within ‘normal limits’. The results of this study show that CV is a more valid indicator of the true lexico‐conceptual skills of a DL child. However, they also show the dangers of testing in only one language or even in both independently. According to these results, the performance of a 5 1/2‐year‐old child in L2 or LI might make him eligible for speech and language therapy. However, his CV SS would not. This type of child may well need help with his second (or first) language but would probably not need language therapy. Finally, the total vocabulary of a DL child should not be assessed as if it comprised two separate languages.
Efficacy of speech and language therapy with children
Authors: LAW JAMES
Published: April 2011

ABSTRACT  A number of themes may be extracted from the published evidence. Three of these will be addressed. Firstly, differential effects of specific therapeutic techniques — directive, interactive, modelling, recasting, imitating, and mileu teaching. Each technique has been shown to be successful, but evidence is emerging for the relationship between input technique and subject variables. Secondly, the relative roles of parent, therapist and peer as the vehicle for the intervention. Traditional ‘consultant’ models have been challenged. The obvious alternative is the parent, but there remains a distinction between parents as ‘assistants’ to therapy and parents as instrumental to change. The latter approach is becoming increasingly popular, although to date such approaches have been less successful in changing syntactic output than interaction. There is also a fear that they may propagate culturally biased models of practice. Intervention programmes using peers are beginning to emerge. Thirdly, the effects of broad treatment ‘packages’ to different treatment groups in relation to no treatment or delayed treatment controls. Early work has given way to more tightly controlled trials on very young children and those in age ranges more conventionally treated by speech and language therapists. Subject variables are more clearly delimited and reported in subjects examining differences in group means. A number of studies provide convincing evidence of change relative to controls. There has also been a slow shift to single case designs. To date, convincing evidence for change by use of this design has only been shown in the area of phonological development. There is an urgent need for both replication and post‐treatment follow‐up studies to establish whether change holds good across different contexts and whether intervention effects wash out over time. There is plenty of evidence for change following intervention, but convincing evidence for efficacy requires further corroboration.
Using teaching packages for staff working with people with learning disabilities
Authors: FRANCES DELIA , MONEY BULPTT
Published: April 2011

ABSTRACT  The communication skills of people with learning disabilities are contingent on their environment. Speech and language therapy service delivery must therefore consider the role of the communication environment, in terms of context, expectations, and conversational partners. However, there is a paucity of evaluative research and information available to enable therapists to meet this need. In spite of this, therapists have responded to the shift of emphasis and begun to develop environmental approaches, based on their own experiences. Approaches vary, but the role of the speech and language therapist to provide teaching programmes for communication partners in the environment has been highlighted throughout. The author's research project aimed to compare three different environmental approaches in order to make recommendations for future service delivery. The three approaches all involved working with key communication partners and were: (1) Working directly on a one‐to‐one basis with the person and partner; (2) Working indirectly by providing a package for partners; (3) A combination of these two approaches. A teaching package, called TALKABOUT, was designed to reflect the partners' needs within their work settings. It is a five‐day course that aims for staff to reach a recognised level of knowledge and competence in communication skills (Money & Thurman, 1994). The methodology of the research project involved random selection into each of the three experimental approaches, and pre‐ and post‐evaluation over a four‐month episode of intervention. The evaluation strategy included videos of interaction between a member of staff and a person they worked closely with, and evaluation questionnaires. The interactions were anlaysed by use of the author's pragmatic framework which records communication in terms of the form, function and modalities used. Results indicated that whilst staff communication changed in all three experimental approaches, overall changes were greater in the combined approach. Staff use of open questions increased by 3.8% and 7.04% in the direct and teaching‐only approach, respectively, compared to an increase of 9.92% in the combined approach. Similarly, the increase in staff use of additional modalities increased by 11.94% in the combined approach compared to 8.12% and 3.44% in the other approaches, respectively. Of the staff who participated in the TALKABOUT course, 90% felt that their awareness had changed greatly and 85% felt strongly that people with learning disabilities had benefited from them attending the course. Informal observations, such as increased staff motivation and interest, also support the TALKABOUT course. In conclusion, these results support the use of teaching packages as an integral part of speech and language therapy service delivery. The role of the speech and language therapist involves developing the communication skills of partners who can then facilitate communication with the person with learning disabilities within their daily environment.
Back to basics: letting the client lead the way
Authors: PEACOCK ANDREA
Published: April 2011

ABSTRACT  Recent interest in high‐technology communication systems should not detract from the importance of allowing the selection of a communication system to be client‐centred using a flexible approach to alternative and augmentative communication (AAC). This paper presents the case study of a 15‐year‐old boy, J, with cerebral palsy (CP). He has spastic quadriplegia and no useful speech. J has been introduced to a range of both low‐ and high‐technology communication systems over the years with varying degress of success. The key to a recent breakthrough in the search for a useful communication system for J involved shelving attempts to introduce a high‐technology system and to return to a low‐technology system where J is the key person in its development. A range of systems had been explored, including the operation of a switch with either head, arm or leg movement. However, J was unable to control any movement with consistency — leading to frustration and loss of motivation. J's main method of communication remained his eye‐pointing which is accurate and consistent. Until recently, the most useful method of communication has been a colour‐coded symbol board on his wheelchair tray, using the ‘Sounds and Symbols’ system. J was able to use the symbols to give information in response to questions, but rarely used them to initiate conversations. Returning to basics has involved incorporating J's accurate eye movements with ‘listener scanning’ and focusing on what motivates him to communicate. As J has always been interested in people in his environment, this became the starting point for developing a personal communication folder using photographs and Mayer‐Johnson symbols. J chooses the topic areas and the specific symbols/pictures which he wants and rejects those he does not want. These are not necessarily what the speech and language therapist would choose! In addition, J decides on their placement within his folder. The development of this folder has been client‐led and has involved looking at J's whole environment, including home, school and leisure time. J is using a combination of his symbol tray and his communication folder in an efficient and successful manner: he now frequently initiates conversation; he is able to express his feelings more specifically, thus avoiding the outbursts of frustration he previously displayed; he now asks questions about others rather than thinking about himself all the time. It is felt that the key to the current success of J's communication has been due to his ‘ownership’ of the system and his responsibility for its development.
Lost for words? Vocabulary selection for communication aids
Authors: WHITTON MICHELLE
Published: April 2011

ABSTRACT  There appears to be a growing expectation from speech and language therapists and VOCA users that the provision of a communication system alone is no longer sufficient. Demands for vocabulary packages to use with a communication aid are increasing. Are such packages the answers to clinician's or user's needs? Given that communication is personal and individual, how flexible can packages be in terms of vocabulary offered and idiosyncrasies in linguistic repertoire for the user? This paper provides an overview of recent research into vocabulary use with communication aids, and examines the possibility of identifying a ‘core vocabulary’ with customisable user options to personalise it. It is hoped that these ideas will stimulate discussion on the topic.