bluuebunny/crossref_metadata_2025 huggingface dataset:
Speech and language therapy in a community clinic: report of an efficacy study
Authors: LETTS CAROLYN
Published: April 2011

ABSTRACT  This paper reports on a small‐scale efficacy study carried out with language delayed/disordered child patients attending a community clinic. The purpose of the study was not only to attempt an evaluation of procedures but also to establish a methodology for such studies that is practicable within the constraints of a working clinic. The design was a set of individual case studies. Six children were selected and a treatment area decided for each, following initial assessment. In each case, the treatment targeted a new grammatical structure or morphological ending. Probes were devised to elicit baseline data on the treatment structures and, for each child, a similar probe was devised for a similar non‐treatment structure. Probes were repeated after each child had received an average of five treatment sessions, with the addition of a ‘generalisation’ probe which tested use of the structure in response to a slightly different stimulus. Further re‐assessment was carried out six months later. The first part of the study is described here. Results after the first block of treatment suggested progress in nearly every case (it was not possible to establish a reliable baseline with one child), but not in straightforward terms of having acquired a structure or not. What emerged was a picture of transitional stages of acquisition, falling into one of the following categories: (1) Acquisition of a form (e.g. morphological ending), but application to only a limited number of relevant lexical items; (2) Acquisition of a grammatical contrast, but not the ability to signal it in the conventional way; (3) Acquisition of a form, but over‐generalisation to non‐appropriate items (e.g. those used in non‐treatment probes). Probes on non‐treatment structures showed no transitional stages, there being either no progress at all or the structure having apparently been learned spontaneously. It is concluded that, whilst it is possible to carry out studies of this kind, care must be taken over measures taken and interpretation of results.
A National Vocational Qualification for speech and language therapists' assistants
Authors: HARRISON PENNY
Published: April 2011

ABSTRACT  This paper sets out the need for a National Vocational Qualification (NVQ) for speech and language therapists' assistants in the framework of national vocational qualifications which are being developed for all sectors of employment, and in the context of the need for a multi‐skilled workforce in reformed National Health and Local Authority Services. At the heart of NVQs is the concept of occupational competence, which is expressed as the ability to perform to the standards required in employment across a range of circumstances, and to meet changing demands. This paper briefly sets out the standards of occupational competence and underlying knowledge which the profession has agreed constitute the role of the speech and language therapists' assistant. The standards will be described in terms of the units, elements and performance criteria on which an assistant can be assessed as competent. Assessment is an integral part of an NVQ award, and the paper will also describe the assessment process, and highlights the responsibilities of speech and language therapists who will need to be involved in the assessment process.
Competency of speech and language therapists to work with acquired dysphagia
Authors: DANGERFIELD LYNN
Published: April 2011

ABSTRACT  Over the past 10 years or so, speech and language therapists have become involved in the assessment and management of acquired dysphagia, prompting much discussion about this new role. Surveys have indicated the growing number of dysphagia referrals (RCSLT, 1992) and the importance of the contribution of the speech and language therapist (Kennedy, 1992). The Dysphagia Forum held in July 1992 (RCSLT, 1992) highlighted some of the concerns of practising clinicians regarding this new role and one of the 10 recommendations following this Forum was for more specific statements to be made about the training of speech and language therapists to work with such clients. Whilst professionally, with the support of the College of Speech and Language Therapists, there is now consensus that speech and language therapists have a role with acquired dysphagia, there remains discussion and uncertainty about the necessary training and competency levels required by therapists to fulfil this role. The current political and academic climate focuses strongly upon competency and being able to prove professional worth and quality of service delivery. It is therefore essential that speech and language therapists have evidence of their competency with dysphagia. Given these issues, the topic of training and competency of the speech and language therapist with acquired dysphagia was chosen for an MSc dissertation carried out at the University of Portsmouth between June‐December 1994
Efficacy for speech and language therapy for dysphonia
Authors: GORDON MARGARET , LOCKHART MYRA
Published: April 2011

ABSTRACT  In order to establish efficacy of any type of intervention for a functional disorder, it is necessary to evaluate the function before and after treatment and to have confidence in the measurements used. Vocal function has many parameters which require the employment of different tests for reliable assessment. The validity of these tests needs to be established by systematic literature review and, where possible, formal meta‐analysis. The US Agency for Health Care Policy and Research (US‐AHCPR) has recommended a method of grading evidence for use in the development of guidelines (AHCPR, 1992) and a similar method could be employed to evaluate the reliability of vocal function tests. Hirano (1989) presented the results of a survey carried out to identify the type, nature, aim and frequency of use of clinical voice evaluation procedures and also reviewed the results of the procedures used in his own department in Kurume, and their reliability in measuring parameters of vocal function. Hirano (1989) made suggestions and recommendations for useful measurements, including perceptual evaluation, visual inspection, tape‐recording, stroboscopy, Fo measurements, sound pressure, level measurement, aerodynamic tests and acoustic tests. A standard, using the GRBAS scale, has been suggested by the IALP Voice Committee for perceptual evaluations, but no standards have yet been agreed for the remaining tests. This paper looks at some of the evidence for assessment standard setting and at reported efficacy studies which have used these assessments for monitoring outcomes.
Parental speech to SLI children and their younger siblings
Authors: CONTI‐RAMSDEN GINA
Published: April 2011

ABSTRACT  The purpose of this investigation was to compare the nature and frequency of parental recasts (both mothers and fathers) to specific language impaired children (SLI) with that to normal language learning children of the same language stage. The comparisons were made within the framework of discourse function to include conversational contingency and conversational breakdown. In addition, the present investigation examined a natural but infrequently occurring situation where a family has both an SLI child and normal younger siblings of the same language stage. It was found that SLI children at the early stages of development (Stage I/early Stage II) experience a simple recast gap in their linguistic input. Furthermore, it was found that the conversational functional context in which simple recasts occurred for SLI children was also different. Further qualitative analysis revealed a preponderance of New Noun‐Phrase Informational Simple Recasts used with SLI children as opposed to New Verb‐Phrase Information Simple Recasts. These results and their implications are discussed within the context of similarities and differences between mothers versus fathers and SLI children versus normal language learning children.
‘The children in focus' — an epidemiological study of speech‐language skills of 1127 children aged 25 months
Authors: LOADER SUE , ROULSTONE SUE
Published: April 2011

ABSTRACT  This paper presents the early findings of a study of the communication skills of 1127 children — ‘The children in focus’. These children, who were all assessed at 25 months of age, are a subgroup of the major Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC), based at the University of Bristol, and involving 14,000 children and their families. It is part of a World Health Organization project designed to monitor and analyse the origins and influences of different factors affecting the health and development of children in Avon, and to collaborate with similar surveys in seven other European countries. The aims of the study are: (1) To gather epidemiological data on the incidence and broad subgroups of speech‐language difficulties, including voice and fluency; (2) To provide a database of information on 1127 children which can be used as part of a longitudinal study to investigate possible causes of and factors influencing spontaneous recovery from ‘late‐talking’; (3) To investigate the significance of clinical features (e.g. imitative ability) in the early identification of persisting speech‐language difficulties; (4) To provide standardised scores for 1127 children for broad phonological processes and an understanding of spoken language, as assessed by the Reynell Developmental Comprehension Scales; (5) To provide data for the numerous collaborative studies in the ALSPAC study (e.g. parental interaction with twins, effect of conductive hearing loss). Research methods included clinical assessment of each child involving the Reynell Developmental Comprehension Scales, a phonological screening procedure based on the work of Pagel Padan Novak and Beiter (1987) and observation. Carer/parental perceptions of their child's communication skills were collected from questionnaires. Data from the main ALSPAC study (for example, medical history) will in the future be related to the findings of the study. The clinical assessment of the children began in July 1994 and was completed in January 1995. Results will include normal distribution curves for the Reynell Developmental Comprehension Scales and normal phonological processes in children of 25 months of age. It will be possible to identify the incidence and geographical distribution of the ‘late‐talkers’ which will be of value in service planning in the future and may help to explain local factors affecting referral rates. It is hoped that correlations between ‘late‐talkers’ and therapists' indicators of concern (for example, poor attention skills) will be found. The future study of ‘The children in focus’ at 56 months will enable the spontaneous recovery of ‘late‐talkers’ to be investigated and also enable a retrospective study of medical, environmental and emotional factors of those children who continue to show speech‐language difficulties to be carried out.
A multidisciplinary approach to the diagnosis of autism
Authors: CLEGG PAT
Published: April 2011

ABSTRACT  This paper describes the development of a local provision for children presenting with a complex communication disorder (autism continuum). The service is organised as a partnership between parents, professionals and voluntary organisations. The paper is organised under the headings: Where we were; Where we are; Where we are going. The content to include: Definition of autism; Joint development of the service; Team structure and network; Parents' information leaflet; Data on children seen, including referrals, results and sample action plan; Pro forma of structured play session with individualised samples; Protocol and audit results; Consumer survey results; Post‐assessment service provisions; Training of professionals; Future developments. Areas for discussion include: Protocol; Assessment process, and Evaluation.
Speech therapy for persistent hypernasality/nasal air escape after velopharyngeal surgery
Authors: SELL DEBBIE , MA L
Published: April 2011

ABSTRACT  The treatment of speech symptoms associated with velopharyngeal inadquacy is frequently surgery. Unfortunately, about 20–30% of cases have persistent hypernasality/nasal air escape after velopharyngeal surgery and, in effect, present as surgical failures. It is the usual practice of surgical colleagues to recommend six months' post‐operative speech therapy in this situation. Very often this can lead to a negative unsuccessful experience for both the patient and the speech and language therapist.

The use of nasopharyngoscopy as a pre‐operative investigation in the assessment of velopharyngeal dysfunction has been well established. Some authorities advocate the use of this technique for the objective assessment of post‐operative velopharyngeal closure, but this is rarely an established standard of care in the National Health Service (NHS). At Great Ormond Street the speech and language therapist is responsible for coordinating the service for velopharyngeal inadequacy and is trained in endoscopy. The model of practice includes a speech tape recording and assessment, and nasopharyngoscopy, at three months post‐operatively. Since 1990, more than 200 consecutive patients have been referred with suspected disorders of velopharyngeal function and entered on the database. To date there have been 63 surgical procedures.

Through the use of video presentations, different examples of post‐operative findings will be presented. Evidence is provided to show that the aetiology of postoperative hypernasality and nasal air escape is variable. For example, the aetiology may be inappropriate surgical procedures, poor surgical technique, habitual factors or variability related to consonant production.

Speech therapy is not always appropriate and should be recommended when the therapist and the surgeon have observed post‐operative velopharyngeal function through nasopharyngoscopy. Sometimes it may be advised for a shorter period than the routine recommendation of six months. Post‐operative nasopharyngoscopy will provide guidelines for appropriate referral, thereby increasing the cost‐effectiveness of speech therapy treatment. In addition, it will reduce the frequent sense of failure and frustration often associated with this treatment — not only for the patient but also for the therapist. It is suggested that the routine post‐operative recommendation of six months' therapy should be discarded in favour of specific recommendations based on the nasopharyngoscopy and speech assessment findings.
The Eurocleft Speech Project: an outline of the results
Authors: GRUNWELL PAMELA
Published: April 2011

ABSTRACT  The Eurocleft Speech Project was established in 1989 to investigate the speech performance of children from six centres in the Eurocleft Orthodontic Study. The project investigated the speech of 131 subjects, aged 11;0–14;0, born with unilateral cleft lip and palate (UCLP). A sampling procedure and an analytical framework were devised for the study which enabled comparisons to be made between the speech results for five European languages: Danish, Dutch, English, Norwegian and Swedish. The analytical framework identified characteristic error patterns in cleft palate speech and focused on the ‘vulnerable’ plosive and fricative consonants that are common to the five languages. The overall resonance characteristics of the subjects' speech were also evaluated. The results indicate good outcomes with regard to accuracy in consonant articulation across the whole population with common minor (subphonemic) errors in all languages for a minority of subjects. The results for resonance characteristics are less positive with slight hypernasality in 20% of subjects. Nonetheless, there are few indications of seriously disordered speech. There are no significant differences between centres. However, the detectable differences match the findings of the orthodontic study, especially in regard to ranking the centres. In addition to these findings, the Eurocleft Speech Project has identified principles and procedures for cross‐linguistic investigations of the speech performance of cleft palate individuals.
Are your minimal pairs too neat? The dangers of ‘phonemicization’ in phonology therapy
Authors: GARDNER HILARY
Published: April 2011

ABSTRACT  To ‘phonemicize’ (Howard, 1993) involves tidying up the phonetic details of a child's utterances in order to fit the tokens into neat phonemic categories which provide clear meaningful contrasts for a therapy programme. Research has highlighted the dangers inherent in such treatment of the child's phonological output. One danger of this approach is that, as therapists, we can overlook vital information regarding the child's true system of contrasts as we only consider the perspective of the listener rather than the speaker. This can have a negative effect on the efficacy of therapy undertaken. The solution to this is accurate, detailed phonetic transcription and analysis of the child's output (Grunwell, 1987). This paper presents evidence of how such ‘phonemicization’ can work against the aims of a therapy programme when the minimal pairs being used, supposedly to contrast the child error with the target version, are not an accurate reflection of the actual child output. The evidence comes from detailed qualitative analysis of filmed interaction between therapists and phonologically disordered children working together. The techniques are those of conversation analysis (CA) as derived from the work of Sacks, Schegloff and Jefferson (1974), and Atkinson and Heritage (1984). This evidence is presented in the form of extracts which show the therapist responding to child error on a target phone by ‘redoing’ (Tarplee, 1989) the child's version inaccurately, but in a way that fits in with therapy design. The child routinely fails to repair the error in such cases. Where the redoing reflects the child's output more accurately than appropriate repair can be shown to take place. CA shows that the way we plan and implement therapy, based upon a theoretical notion, becomes explicit through the clinical interaction. Careful phonetic assessment should lead to a therapy programme that more accurately reflects the child's difficulties and to more appropriately handled repair sequences that help the child address his error effectively. This, in turn, should enhance the therapy process.
Facilitating phonological awareness in 3‐ and 4‐year‐old children
Authors: INNES SARA
Published: April 2011

ABSTRACT  There is evidence that awareness of phonology emerges in early childhood (Chaney, 1992), being exhibited by preschool and pre‐literate children, although rapid development can be seen in school age children. Most previous metaphonological facilitation studies have focused on school age children (Cunningham, 1990; Lie, 1991) while few others have studied young pre‐schoolers (Byrne & Fielding‐Barnsley, 1991). The present study investigated the effects of a short‐term facilitation programme aimed at increasing the phonological awareness of preschool, pre‐literate children between 3 1/2–4 1/2 years of age. Forty‐eight subjects were assessed both before and after a four‐week intervention phase on measures of metasyntactic ability, auditory memory, auditory discrimination and four measures of metaphonological ability. Following the pre‐intervention assessments subjects were allocated to one of three groups (groups A, B and C) each containing 16 subjects and matched for age, gender, social background and linguistic ability. Group A received a programme specifically designed to facilitate metaphonological abilities in eight half‐hour sessions. The first control group (Group B) received the same amount of input with a programme targeting semantics instead. Group C, the second control group, received no intervention.

No statistically significant difference was found amongst groups A, B and C for any of the pre‐intervention assessment measures (p>0.0). The increase in mean combined metaphonological score from pre‐ to post‐intervention testing for Group A was significantly greater than for either Group B (p=0.0016) or Group C (p=0.0015), whereas the two control groups did not differ significantly from one another (p=0.6917). No significant difference was found amongst the three groups for any other measures (p>0.1).

The results indicate that the metaphonological intervention programme significantly influenced the metaphonological abilities of 3‐ and 4‐year‐old children, whereas the control conditions had no such effect. It is suggested that a metaphonological intervention programme would benefit preschool, pre‐literate children in their preparation for school and their pursuit of reading readiness. Preschool children have disparate levels of metaphonological ability having had different metaphonological experiences. Not all children are equally ready to develop literacy skills when they start school. Children with poor phonological awareness, especially those with delayed or disordered language, are thought to be at risk of future reading difficulties (Schuele & Van Kleck, 1987) and would particularly benefit from preschool metaphonological intervention.
Is it memory or phonological difficulty?
Authors: TREHARNE DILYS , DOWLING SARAH
Published: April 2011

ABSTRACT  The continuing discussion concerning the relationship between short‐term auditory memory (STAM) skills and phonological difficulties was explored in one subject (aged 12;11) with a residual immature speech pattern, poor auditory and phonological analysis skills, and specific language difficulties. The views to be considered include: (1) That poor STAM reflects a weak knowledge of language (Bloom & Lahey, 1978); (2) That poor storage within STAM results in language difficulties (Gathercole & Baddeley, 1990); (3) That phonological processing difficulties lead to imitations in the phonological component of working memory (Brady, 1991); or (4) That there is a disassociation of phonological processing skills and STAM (Pennington, Van Orden, Kirson & Haith, 1991). A battery of five experiments to test components of the working memory model designed by Gathercole and Baddeley (1990) was administered. These consisted of non‐word repetition, serial word recall of phonologically similar and phonologically dissimilar words, an auditory discrimination task, and two tests to assess speech rate. The first two tests are felt to assess phonological memory skills. The tests had previously been administered to a group of 10‐year‐old dyslexic subjects and their normal age‐matched controls by Nicolson and Fawcett (personal communication).

The subject converted non‐words to real words or phrases retaining the syllable structure. He did not show evidence of a phonological similarity effect, indicating that he may have been relying on information other than phonological. He displayed some phonological discrimination difficulties. His articulation time was slower than the dyslexic subjects and the controls, especially for long words. His voice latency was difficult to evaluate. It appears from this evidence that the subject was attempting to use his weak phonological skills, but was supporting these with other, possibly semantic, skills.

The results appear to indicate that the subject has a weak phonological store in his working memory. It is difficult to argue, though, that the capacity of the phonological store has affected the subject's auditory and phonological difficulties. It would appear that perceptual and phonological processing difficulties have resulted in the subject attempting to utilise other linguistic skills available when pressured to analyse speech. This explanation would reinforce the arguments of Bloom and Lahey (1978) or Brady (1991). This allows the professionals working with the subject to consider multiple strategies for word recall, analysis and manipulation, possibly drawing on the semantic strategies he is already developing.
Speech motor control in children with phonological acquisition difficulties
Authors: WATERS DAPHNE
Published: April 2011

ABSTRACT  A brief report is given of an investigation of level of maturity of speech motor control in a group of 12 phonologically disordered children aged 44–58 months. The study uses spectrographic analysis of multiple token connected speech data elicited by delayed imitation. Results give some support to the view that poor speech motor control may be a factor in developmental phonological disability. Implications for assessment and therapy are discussed.
Classification of acquired language disorders in childhood: the next step?
Authors: LEES JANET
Published: April 2011

ABSTRACT  This paper is part of a longitudinal study of the recovery of 34 children with acquired aphasias. Lees (1993) reported that two classification systems currently used in clinical practice failed to account for the language disorder subtypes seen in at least half of these children. This paper takes another look at children whose language deficits could not be classified according to either the Rapin and Allen (1987) or the Goodglass and Kaplan (1972) models. It takes up the point made by Lees (1993) that ‘our understanding of acquired childhood aphasia would proceed better if we respected the need to describe it carefully’ and seeks to do just that.
Is oral narrative ability a reliable predictor of reading competence?
Authors: DISKIN JULIE
Published: April 2011

ABSTRACT  This paper presents a summary of findings from a study of primary school children aimed at investigating if narrative skill could predict their reading ability. The results indicate that this is so, suggesting that emphasis needs to be placed on narrative development.
Wider access to higher education: after the three R's — the three T's
Authors: STEPHENS CHRIS , GROEGER JOHN A
Published: April 2011

ABSTRACT  Access to higher education has been greater in recent years than ever before. As a result, institutions are increasingly confronted with student populations with a broader range of abilities than would traditionally have been the case. The student with learning difficulties could experience unexpected hurdles, having been accepted on to a course. This paper considers the assessment process available at Leeds Metropolitan University and describes the difficulties of students with specific learning problems and the challenge it poses for those working as specialist tutors. Of particular interest with this population is the fact that the median score on the Bangor Dyslexia Test (Miles, 1983) was 5.5 positive indicators with a range from 1.00 to 9.00. It is concluded that the issues of assessment addressed in our analyses highlight some specific learning problems experienced by a minority of students in higher education, where provision of Therapy, specialist Teaching, and Technology (the three T's) is inferred to meet their learning needs.
Accuracy of prediction of language abilities by relatives of long‐term aphasic patients
Authors: McCLENAHAN ROSHAN , LYNCH CATHY , HAMMETT NICOLA , WEINMAN JOHN
Published: April 2011

ABSTRACT  British and American research has demonstrated that relatives of cerebrovascular accident (CVA) patients underestimate the linguistic impairments in their aphasic relative. It is important that the reasons for this inaccuracy, with its effects, are ascertained so the management of these patients and their relatives can be handled more sensitively. None of these studies researched the effect of the linguistic misperceptions of the carers on the patient. It is possible that the misperceptions lead carers to use and expect language that is too complex for the patient. This may lead the patient to become frustrated and, possibly, depressed. This study aims to confirm whether carers of long‐term patients aphasia are similarly inaccurate at estimating language problems in their relatives. It also studies the modd of the patient. Twenty‐nine carers of long‐term aphasic patients (from 11 months to eight years (mean 31.9 months)) were asked by speech and language therapists to predict how their relative would perform on the verbal sections of the Western Aphasia Battery (WAB) (Kertesz, 1982) and of the Functional Communication Profile (FCP). At the same time, the patients were tested on the same tests by final‐year student speech and language therapists who also tested the patients on the Raven's Coloured Progressive Matrices and on a visual analogue scale of mood (scale of 0–100, with 100 being ‘very happy’). Results showed that the relatives of long‐term patients with aphasia were accurate at predicting both comprehension and expressive problems on the WAB (Wilcoxon matched‐pairs Signed‐ranks Test: z = 1.0812, p = 0.28; z = −1.7838, p = 0.07; z = 0.8994, p = 0.37; z = 0.4318, p = 0.67), but not on the FCP' (z = −2.9516, p = 0.00). Overall, the patient sample was not found to be depressed (mean = 72.6, range 38–100). Furthermore, there was no correlation between the patient's mood and the discrepancies between relatives' and patients' scores, but mood was related to the age of the patient (r = 0.48, p = 0.01). Living with the aphasia helps carers to have a realistic idea of their aphasic relative's linguistic abilities. Speech and language therapists should continue to endeavour to find ways to help carers obtain a realistic picture earlier on in the illness.
Electropalatographic study of speech sound errors in adults with acquired aphasia
Authors: WOOD SARA E , HARDCASTLE BILL
Published: April 2011

ABSTRACT  There is considerable disagreement in the literature as to the precise nature or source of speech sound errors found in clients with acquired aphasia. Traditionally, a dichotomy between apraxic errors and phonemic paraphasic errors has been used to describe the speech errors made by these patients. This motoric‐linguistic division has been the centre of much debate. Researchers have reported overlap in the descriptions of apraxic and phonemic paraphasic errors despite the assumption that these errors arise from different levels in the speech planning and execution process. Recent research using electropalatography (EPG) has provided valuable spatial and temporal information about speech sound errors in clients with acquired aphasia previously unavailable through perceptual‐based analysis (Edwards & Miller, 1989; Hardcastle & Edwards, 1992). This study identifies, by means of EPG and acoustic analysis, regularities in the patterns of speech sound errors produced by five aphasic adults with different diagnoses. The classification scheme described by Hardcastle and Edwards (1992) is tested on these clients and the advantages of a fine‐grained analysis based on instrumental data exemplified. One hypothesis to be tested is that those errors previously identified by auditory analysis alone as linguistic in origin may more appropriately be regarded as arising from a motor programming deficit. This hypothesis is supported by results from the pilot study which investigated the speech sound errors of one aphasic patient considered to demonstrate phonemic paraphasia. These findings have important impliciations for speech and languge therapists. They can lead to improved diagnostic procedures and subsequently more effective therapy which can specifically target or compensate the source of the disruption.
A feasibility study to investigate the use of computers to provide additional aphasia therapy on a rehabilitation ward
Authors: GIBSON ALISON
Published: April 2011

ABSTRACT  This year‐long project is based on the rehabilitation ward of Frenchay Hospital. The patients included in the project have a diagnosis of cerebrovascular accident (CVA). Several studies have already demonstrated the usefulness of the computer as a tool in therapy at the later stages in recovery from stroke. The main aim of the project was to assess the feasibility of providing ward‐based computer‐assisted therapy in the early stages of recovery as a supplement to regular aphasia therapy. Further aims were to assess the acceptability and usage of the computer and to establish the type and number of patients for whom this approach was suitable. All the patients referred to speech and language therapy on the rehabilitation ward were screened for suitability. Criteria for acceptance to the project were established. Over a period of eight months (at the time of writing), 32 patients were assessed. Ten of these had a speech and language diagonsis of dysarthria/dysphagia; three dysphagia; five dysarthria; and 14 dysphasia. Of the patients with dysphasia, four failed to meet the acceptance critieria (one was illiterate, one was depressed and two suffered further strokes). The remaining 10 received computer‐assisted aphasia therapy on the ward. Sessions were supervised by the speech and language therapist three times a week. The computer was, however, available to the patients at all times. A variety of software was used and exercises were tailor‐made to suit the client's changing needs. Two severely aphasic patients were only able to use the computer with the help of the clinician. They used a trackerball and the concept keyboard as input devices. Progress was minimal. The five moderately aphasic patients were able to follow through the exercises alone if the programme was started by ward staff or relatives. They were able to progress to using the keyboard as an input device and, by discharge from hospital, four were able to load the software unaided. The three patients with mild dysphasia were able to use the computer unaided. In these last two groups, progress was clearly reflected in the results that are stored on the disc for analysis. On discharge, a questionnaire was given to participating patients. All reported that they very much enjoyed this approach and found it very helpful. Only one had used a computer previously. All participants worked on the computer most days whilst on the ward, with one reporting more use than once a day. A further questionnaire has been devised for ward and therapy staff to assess their attitudes to this approach. The results of this are not available at the time of writing. It seems that patients with a mild or moderate dysphasia benefit most from this approach. The results recorded provide useful information on progress. Most importantly, the computer allows the patient unlimited access to an enjoyable form of intensive language remediation.
An investigation into the training and development needs of bilingual workers in community settings in the NHS
Authors: HOOKE ED , LEATHER CHRIS , WIRZ SHEILA
Published: April 2011

ABSTRACT  Two of the authors, Ed Hooke and Sheila Wirz, are involved in a project examining the training and career development needs of bilingual workers working in the NHS in community settings. A particular focus of the study is how these issues relate to the delivery of speech and language therapy services. In 1992, the Government published a White Paper, entitled ‘Health of the Nation’, in which it demonstrated its awareness of the particular health needs of people from ethnic minority groups, ‘It will be necessary to consider both the implications of… differences for overall strategies and also to ensure that the specific needs of the people in black and ethnic minority groups are targeted’. Many services employ bilingual workers to facilitate access for people who are from ethnic minority groups and who speak little or no English. These workers are employed in a variety of roles with various titles, including bilingual co‐workers (for example, College of Speech Therapists, 1991), health advocates, sessional intepreters, and link workers. However, there may be problems for these workers in terms of status, career structure, access to training, confidentiality, etc. In December 1993, the Secretary of State launched a ‘Programme of Action’ to promote equality of employment for ‘… ethnic minority staff in the NHS’. This programme ‘… addressed the barriers facing ethnic minority staff and which sometimes prevent the NHS from providing the best possible care for all its patients.’ The first two (of eight) goals in the Programme of Action relate to ‘ “Recruitment and Selection” of ethnic minority staff in areas and grades where they are under‐represented and “Staff Development” to maximise the skills and potential of all personnel in a multiracial NHS workforce’. The training and career structure of bilingual workers in the NHS community settings is the stimulus for this investigation. This presentation sets out to give an increased understanding and awareness of the work practices of bilingual workers and their relationship with clients and health professionals. Profiles of bilingual workers from different Trusts are compared, including recruitment patterns, pay structures, qualifications, and existing training aspirations. The study seeks to identify, through interviews, the training needs of bilingual workers as perceived by them, their managers and professional colleagues (initially concentrating on speech and language therapists), and to identify specific training materials for meeting these needs. The question of whether training needs could be met through NVQs for assistants in therapy services is also addressed. The project is being conducted at the Centre of International Child Health at the Institute of Child Health in collaboration with Camden and Islington Community Health Services NHS Trust which serves a population with a large proportion of people from ethnic minorities. Funding is from the Department of Heath NHS Management Executive.
A model of change
Authors: TURNBULL JACKIE
Published: April 2011

ABSTRACT  Speech and language therapists work to effect change in their adult clients' behaviour and/or attitude to their speech problem. In order to be equipped to do this most effectively, it is important that therapists have a model of change which not only explains the ‘how’, ‘what’ and ‘when’ of change but also the reasons for what is commonly labelled ‘lack of motivation’, for failure to change and for relapse. Prochaska and DiClemente's (1983) transtheoretical model provides such a structure. Change is viewed as rarely occurring in a linear way but as a spiral, with periods of recycling being the norm. The model is most commonly associated with addictive behaviour but can be equally well applied to any type of intentional change. Examples in this paper are given of its use with adults who stammer. The model identifies the processes (the ‘how’) of change which are used in self‐ or therapy‐led change and suggests ways in which these may be selected most appropriately. Hierarchically ordered levels (the ‘what’) outline the content of change. Historically, systems of psychotherapy are seen as having tended to focus at one or two levels only. Prochaska and DiClemente (1994) feel it is important that, if therapy is to be successful, some agreement exists between client and therapist as to the level at which the problem is attributed and intervention is initiated. The stages (the ‘when’) of change are perhaps the most interesting and important features of the model. Currently, six stages of change are described (Prochaska et al., 1994), with appropriate strategies to help move the client on in the process. The first stage is pre‐contemplation in which the client does not intend to change and may be resistant. In the second stage, contemplation, the clients accepts that he has a problem, considers doing something about it, but is not (as yet) committed to action. In the preparation stage, the client begins to plan the changes he will make, although he may still have some ambivalence. The action stage is where the change actually occurs. This is followed by maintenance — a period of consolidation in which the new behaviour or attitude becomes established. If this stage does not last sufficiently long, relapse is inevitable. The final stage, termination, is a long‐term goal which some people never reach.
The impact of gender and attractiveness on observer perceptions of stutterers
Authors: NYE CHAND
Published: April 2011

ABSTRACT  The purpose of this study was to investigate the role of physical attractiveness and personality, intellectual and social characteristics in observer perceptions of stutterers. A total of 140 observers representing four groups: professional business men (PM) (N=28); professional business women (PW) (N=27); blue collar (BC) (N=17, 5M, 12F); and students (ST) (N=68, 5M, 63F). Attractiveness was determined by asking 45 judges (24F, 21M) to rank order photographs of four male and four female young adults. The attractive and unattractive males were ranked first and last by 93.33% of the judges, whereas the attractive and unattractive females were ranked first and last by 100% of those surveyed. The four individuals identified above were trained to imitate a variety of fluency patterns and secondary characteristics of stuttering during a video recorded reading of the ‘Grandfather’ passage. Each speaker received an overall score of 31–36 severity rating, based on the Stuttering Severity Instrument: For Children and Adults (Riley, 1980). By use of a format as as Likert Scale questionnaire, each observer rated each speaker on a seven‐point scale. All observers viewed and rated videotaped presentations of attractive and unattractive male and female stutterers for personality, intellectual, physical and social characteristics. The data revealed no significant differences with respect to the individual group ratings for the unattractive stutterers. However, a significant omnibus F was obtained for the group ratings for the attractive subjects. Additional data will be presented regarding the nature of observer ratings based on the gender of the stutterer.
Emotional and behavioural problems in children — a growing awareness?
Authors: WINTGENS ALISON M
Published: April 2011

ABSTRACT  This paper considers recent research into the incidence of emotional and behavioural disorders with communication disorders and discusses their relationship. It explores why this area of work may be more complex and prominent than before, and suggests ways of managing therapy for this client group and equipping therapists in the 1990s and beyond to deal with them.
Research to practice: an evaluation of Gentle Teaching behaviour descriptions
Authors: STANSFIELD JOIS , CHESELDINE SALLY E
Published: April 2011

ABSTRACT  Gentle Teaching (GT) is a non‐aversive approach to challenging behaviour. It adopts techniques of ignore‐redirect‐reward and environmental structuring in order to manage challenging behaviour. The central tenent of such an approach is the concept of human presence as a rewarding experience. The approach requires carers to initiate and establish new interaction patterns based on unconditional regard (value) for the individual, regardless of his or her behaviour (McGee & Gonzalez, 1990). Early work on GT has had the tone of religious evangelism, with authors making claims and counter‐claims over the benefits of the approach. In 1990, McGee and Gonzalez introduced an interactional observation coding system in order to identify behaviours of carer and client in an interaction as an attempt to enable behaviours to be quantified. Ten children (seven boys, three girls) with severe learning difficulties were videotaped with teachers and a speech and language therapist in a variety of individual and group activities. The children's age range was 13;2–16;10 (mean 15;5). Nine of the children had been identified as exhibiting challenging behaviours, whereas the tenth was included in order to maintain familiarity with the group. Thirteen hours and 24 minutes of tape were edited into two‐minute segments and a total of 63 clips were randomly selected for analysis. The clips were transcribed orthographically and behaviours of the children and staff were coded by use of the McGee and Gonzalez (1990) coding system. The chi‐squared test was used to analyse goodness of fit for each category of behaviour identified in the coding. Significant differences were noted between speech and language therapists' and teachers' interactions with the children, with the speech and language therapists being more likely to ‘assist warmly’ in group work. Children were more likely than predicted to exhibit positive behaviours (for example, ‘value reciprocation’) in individual sessions. Codes for challenging behaviours were very little in evidence, although they occurred to a greater than predicted level with teachers. The codes for adverse carer reactions, such as ‘assist demandingly’ or ‘restraint and punishment’ were also little used. The categories devised by McGee and Gonzalez (1990) are of value, although they fail to account for the complexities of group interaction. This approach to coding and analysing behaviour can reorientate the carers' approach by focusing on their own role in an interaction. It has potential as a research measure and, if used in conjunction with computerised event recording, could become accessible as a therapeutic tool.
Study of raised symbolic communication systems for visually impaired people with additional learning difficulties
Authors: HENDRICKSON HELEN , McLINDEN MIKE
Published: April 2011

ABSTRACT  Individuals with a severe visual impairment will have difficulties in accessing conventional picture/print‐based symbols. They will, therefore, be more reliant on tactile/three‐dimensional symbols, for example, braille/objects of reference, as part of their everyday learning. This paper outlines the options currently available for the population of individuals with multiple disabilities and a visual impairment (MDVI) and reviews the main issues to be considered in developing an appropriate system to meet the communication needs of the population.
Non‐managerial supervision as a statutory requirement for the speech and language therapy profession
Authors: GREEN ROBERTA
Published: April 2011

ABSTRACT  Speech and language therapists at all levels are working in depth with patients, clients and their families suffering from varying degrees of loss. They are also employed by institutions having their own problem of loss stemming from changes, cost improvements, and competition. All this subjects them and their managers to a degree of stress that could result in burn‐out and an exodus from the profession. This was highlighted by a recent case which cited employer's responsibiity in employee risk management. This paper presents a multidisciplinary pilot project setting up a staff risk management and support programme, its effects and benefits.