Speech - Language rehabilitation for children in Switzerland

Speech - Language rehabilitation for children in Switzerland

Resuincii 1 ;I iei.;iptutiCa ciel hahla para 10s i i i l i o s !a h e n conocidu en Suiza. pero no todas las regiones ctientan con ella cn u n niismo grii~io. La cdid rnedia clc IDS iiifios quc lo rec,iben c\ 7.9 a h . stecornicnm tan tardio dcl tratainicnio ocasiona qiie 6ste dure mis . 1-0s gastoscorrcn a

iirstitucionc~, qiic 10s comp;irten. pcro en mayou pal-te soil a cuenta dc Schweizerische Invaliden-Versichcrung. Ncccsita cimiciito del puhlico. c i i m a y o r clcialle. el signilicado de la rehabilitacibn del hahla y d c l lenguajc.

Key MII I . (~ lnsitiutions - Numhei- 01' Iangtragcz - 1.anguagc and speech disabilities - Finances - Tlierapy

In curiiI'a\t to speech and language rehabilitation fhcilrties for adul! piilien1s being practised in a few clinics and in private speccli rehabilitation centres. we find special cines for children i n all parts ot'Switzcrland. Looking a1 speech and l a i n -

guagc rchabilitation de\ielopment in this country we note that i i \ origin comes from teaching and educating deaf and hca ri i1g-i mpai red chi Irlrcn.

The. lirst cstahlished speech and language therapy di\ 'Iblons ' '

datc luck lo around 188U. Thcrealicr. t'or many ycars there was onl> hlow development. During the First and Second Worh! Wars. speech a n d language rehabilitation hcilities iinpro\ ed and developed steadily. Atier the end ofthe Second Worlil War the first collcgcs for training speech therapists wei-c. Iotriided (Zurich, 1947; Freiburg, l949), I t took anolhrr 10 >c;ir \ lor oilier institutes to follow: Geneva, 1961: Nctien- bur-g. 1963: Bnsel, 1967. anda second cdlege in Zurich, 1972). A1 ~ l i ~ , tnd of1978 the BSL (Berufkverbancl Schweizcr Logo- piidcii) w a s founded. This association orientates ltselfoii an intcwiaiional lcvel and issues recori~rnendations concerning stankircts. quality. and duration ofspeech and language therap! IoI adults and children. In general. the importance of language (being the superior mean5 of human conimunica- l i o n 1 was nol properl) rccognizcd; consequently speech and langii;rgs iherapy was dcnied its proper place.

I t I \ known that ii person with a speech defect is often niii-.issigned as being mentally handicapped. For example, an oldcr child with specch dcfect is. in inany cases, "labelled" 131 \ociely a s ;t member with reduced rights. At the same time in ni.rny places and regions people are unwilling to spend any monq on speech a n d language therapy. We face a parrrdos- ical iituation. comparing persoiis with mobility handicaps

receiving treatment h r more easily and naturally th:un rhosc handicapped in speech and language. Let us hope that intcn- sified research and educational activities, a s well a s more realislie and relevant public information, will mitigate these grievances. Summarizing thc present situation in speech ;ind language rchabilitation systems i n Switzerland, we attempt to give answers to the following points:

( I ) geographioal location of institutions oll'ering speech and

(2) number of children needing speech and language thera-

(3) the kind of speech and language disabilities that are being

(4) kinds of institutions in Switzerland; ( 5 ) who finances the speech and language therapy and who is

responsible for the employment schenic for spcech therapists:

language therapy treatment:

P!';

treated in Switzerland;

(6) therap)!.

(1) Geographical location of institutions

Speech therapy facilities for. children are widely spread throughout the country. They do. of course, ditt'er consider- ably in their capacity i n certain parts ot'Swilzerland. 111 all there are more than 1000 of these institutions, covcring both child and adult speech therapy centres. Considering, however, that the number of centres for adult patients reaches only some 30 locations, this aspect will not be included in this paper.

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I n / R t h h r l . M d , 1984; vol. 6 , no. 3

Theraov hours p w A000 lnhab

Supply position of speech therapy in Switzerland

Figure I (from Motsch,’ p. 249, slightly modified by the author) shows that the French-speaking part of Switzerland dyers the greatest possibilities for speech and language therapy, amounting to an average of 5-10 hours per week per I000 inhabitants. In most of the German-speaking cantons only 3-5 hours’ therapy per week per 1000 inhabitants are givcn. Thc figure reached in cantons with prevailing moun- tainarcasshowsonly0-3 hours’therapyper week. Thereace various reasons for these disproportions:

(a) reduced population density in the cantons with large mountain areas;

(b) speech and language therapy centres are located only in larger towns - consequently, the therapist and the child have too Far to travel;

(c) ditrerent political and economical policies pursued by loca I governments ;

(d) difticulty in recruiting capable specialists for assignment in lcss attractive mountain regions.

I n Switzerland, a multilingual country, the question is raised of which language the Swiss therapists use in treatment. The answer to this is that wherever possible the child’s home dialect should be preferred, but the choice is great for there are many dialects in each of the four official languages (French, Italian, Roman, and German). Before commencing therapy. thc consulting specialist must be familiar not only with grammar and word usage in the child’s home country, but also with the dialect of the parents. These facts must be taken inlo full account as they play a vital role in the pro- cedure. I n many cases, speech therapists choose to work in that part of the country where their own dialect is spoken.

Greater problems arise with children ofcompletely foreign origin (i.e. from Spain, Greece, etc.), where one of the parents, or ii close relative, has to take up the role of an inter- preter. Once the initial difficulties are overcome the therapy lessons begin to be held in the language ofthe place where the child is living at present.

(2) Number of children needing speech therapy

The figures differ from region to region. Some recent surveys and investigations reveal that the most affected age is that of pre-school children. Indeed, 15-20°/o ofthe children up to the age of 6 itre said to need therapeutic help (kindergarten- age = 5-6: school age = 6-7 years ofage). The help may be in the form of special instruction and/or informative advice to parents, or it could be a fom of direct systematic introduc-

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lion of speech therapy treatment. With children at school. aged between 7 and 9 years, the average figure reaches about 8% (according to information from the Heilpiidagogisches Seminar, Zurich, P. Wettstein/U. Coradi, 1983).

Only heavily impaired children are statistically recorded because their therapy costs are carried by the Swiss Insurancc Scheme for Disabled (Schweizerische Invaliden-Versichc- rung). According to the 1981 report issued by cantonai departments of education, nearly 13,000 ofa total number of‘ ca. 900,000 children between 5 and 15 years of age wcre registered for the beginning of intensive speech therapy.

(3) What kind of speech and language disabilities are being treated in Switzerland ?

We find that these disabilities very rarely appear in the form of one single isolated syndrome. In most cases the single disturbances are linked together and result in a whole corn- plex disorder. Minor deficiencies may relate to speech disorders. In spite ofthe complex character, the pathologist is able to recognize and list the different types of language defects as fo I1 0 ws.

(3a) Dyslalia Dyslalia, being a disturbance ofarticulation, is lacking single phonetic sounds and sound combinations. Some of them may be replaced by other sounds in an abnormal manncr.’ The therapy is aimed at correcting the articulation and the sound of the words.

(3b) Retarded speech and language development This can be a result o f t h e following defects: brain damagc (pre-, per- or post-natal); hearing damage or disability; nio- toric defects (tactile-kinaesthetic); mental handicap: anom- alies (cleft palate, etc.). T h e therapy should always follow thc level corresponding with the child’s capability. All f’unda- mental functions of the speech performance must be trained with great care to achieve correct development. The produc- tion of speech has to be guided and supervised.

(3c) Rhynophonia aperta and clausa “Aperta” means too much air flows through the nose while speaking. T h e cause of this is mostly of an anomalic ana- tomic origin (cleft palate, etc.). “Clausa” means too little air passes from mouth to nose, causing faulty resonance. This phenomenon can be due to a tight air passage from mouth to nose, proliferations or functional disturbances, etc.

There should be an early assessment by a team consisting of medical doctors, speech therapists, and the parents, the hypothesis being that intensive, competent treatment will prevent wrong attitudes, as the longer wrong habits are left unattended, the more difficult they are to eliminate.

(3d) Dyslexia Many different causes lead to this syndrome of difficulty i n learning to read: central or peripheral disturbances; retarded language development; deviant language developmcnt : psychological factors, etc. The same rule as already mentioned in (3b) applies here: namely, consequent training ofall fun- damental reading and writing functions in order to synchro- nize the whole process.

(3e) Stuttering This means disability in speech fluency (interference i n speech flow) resulting in disturbed communication. The reasons that lead to stuttering are of different origin, depending on which way we look at the process and its development.

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SC'HALC H: Speech - language rehabil i tat ion tor chilclren -~

Therc 15 sonic evidence to suggest that thesc iirc thc following predisposing factors: hereditary taint : ni i n or brai n cia t i i age during ca r11 chi Id hood : en v I ro t i in e n t a I a nd ps y c I1 o I ogi ca I factor5 T'odaq there are innumerable theories dealing with the C;ILIW and t reatment ol'stuttering. However. they all have one conin ion target - to help the child regain speech tlucncy withoui ;I loss of courage and self esteem.

(39 Cluttering Accortling to Hecker and SoLak.' cluttering is ;I striking k i n d ofdihtui.bancc i n speech coordination. I t seems to be a result ofexcc~.; i \ el\, xcelerated speech flow. Therapy is directed to help g i i n control 01' the spced rate and to improbe self- mon i t ori iig.

(3g) I)!sgrainmatismus Dysgraiiiiiiatismus is said to be a central disturbance, where the application of morphology (science of structural \)aria- tions t>i words; word fle\ion in decline)and syntax (science of sentcnc i' construction: correct word arrangement) in accor- danct. \ I i t l i t h e grammatical rules o f a language is not de\,cl- opcd appropriately. (The child is not d ~ l c to interpret and to titili7c mrrcct l ! the rules which are indispensable fbr ade- qua tc pi;iiiiiii:ir und use of language.) Verb olicn ii child suffering tiom ~fy\gratiimatisiiitis is also showing lexical shor t - ness oi \ocabulnry. Thc reasons for clysgranimatic distur- banccs c';in hc of different kinds: brain daniage; hearing clis- abilit! . retarded mental development : learning disability: lack 01 language stimulation. etc.: illness and/or accident w i t h c( n \cq tic n t d y sgra ni mat i sni us. T h c t lie ra p 5 t rea t ni en t invol\ cc, the child's whole environment and the consulting speciiilibt has to bear this in mind, whilst working out pre- cisel! ;ill the ditr'erent rules and methods 111 order to help the patient 1 0 attain coniplete fluent and correct speech perfor- ma ncc.

(3h) \phasia We \ ic\+ this tcrm as only being applicable to children who are a I r ~ ~ , i c l ~ i n hull possession of 21 language and who have

ccl ihrough all the clitl'erent phases ol'languagc development. A t k r Brookshire.' al71i~~Fia;dyspliasi~i is a deficiency in procchsrng s\ mbolic materials present in all stimulus (audi- tory, I I \ L I ; I ~ . t;rctile)and responsc (speaking, writing, gcstures) moda I i t i c:, . 7' his d i sa b i 1 i t 1 oft c n in v o I vcs word - ti n d i ii g d i lfi - cult! :ind ii reduced retention span. However. not all perfor- manc'cs ;I rc cq ua I1 y atfected.

Apliii\ia C;in he a result 01': brain daniage: cerebral vascular accident\: \pace-demanding processes such as tuniours. etc. Apha\ici should be treated b) a team comprising ncurolo- gists, ot~cup;itional therapists. medical doctors. specialist n u rseb. is rgo t Ii e rapists, and speech pat h o I og i s t s .

( 3 ) \'oice disturbances Somc 0 1 the inany cause5 Ibr voice disturbances are: organic anomalic\: paralysis: tumours; voice abuse (continuous shouting o r voice pressure): psychological o r psychogenic factor\. ctc. Generally, people pay little attention to boicc disturh.iiiccs. although these cases arc quite freclucnt. Fur- thcrnioi-<. \,oicc disturbance is often not considcred to be a handicap. .At this point we wish to cmphasi7e that parents and tt,a< hers (particularl! kindergarten stat11 should contin- uousl\ be inliirnied and educated on the importance ol'voicc and i t \ iunctions. The therapist's target is to help the child makc marc ellicktit use ol'his voice and to eliminate wrong speak i ng habits.

Prevalence of speech and language disorders

M o t s c h (p. 2 5 5 ) tried to provide an answer to this problem. He failed to do so in the sense of the Swiss general survey which. in several cantons. did not take inlo account cases of children with reading and writing disabilities. receiving trcat- ment given by specially trained teachers. Conhequently this survey can be considered as representative in scvcn cantons only. where exact records ofall different speech and language therapy applications exist.

The cases ofchildren who attended spcech therapy lessons are classified and rated as follows:

I . 7 -.

3 . 4. 5

6. 7. 8. 9.

_ .

Dyslexia Retarded development o f spccch and language Dyslalia Stuttering Central disturbances (dysgrammatismus. aphasia, etc.) R h i t i o phon ia Voice disorders Cluttering Other

'The reader niay also be interested in the average age of children who received speech therapy lessons. The dilkrent age levels range (after Motsch 1981)' as follows:

children aged 0-6 years children aged 6-10 ycan children aged 9-14 years children aged 14-20 years

The relatively high Swiss average age ligure of 7.97 years may surprise the reader. Reviewing the classified figures we find two kinds of disability at a strikingly high percentage level (dyslexia and retarded language development). Detailed in format ion extracted fro in general population surveys (mainly from kindergarten) reveals even more startling facts: around 15-25YC of all children are suffering from some kind of disturbed speech and language pattern. It is well known that speech and language defects - most of which clearly originate in the period of language acquisition - are adversely affecting communication and the whole general learning process. Basically, all these "surprising". "striking". and "alert- ing" facts are the result of the following mistaken attitudes and misjudgments on the part of parents and the general public:

I . hesitation of parents to seek early help from a specch therapist:

2. failure to realize the importance ofsupervised speech and language therapy lessons preventing many comniunica- tion disorders at later stages.

(4) Kinds of institutions in Switzerland

There are several diffcrent kinds of institutions i n Switzer- land o fferi n g speech and la nguage therapy treat m e n t : (a) consulting rooms, ambulatorium (mainly for children

aged 5-15 years): (b) speech therapy kindergartens, designed for sniall groups

of children o f pre-school age (5-7 years): ( c ) special speech therapy boarding schools; (d) hospitals and clinics (mostly for treatment 01' heavily

impaired children):

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] t i / . R i h h i / . M d . , 1984; vol. 6 . no. 3

(e) therapeutic-pedagogical institutes, functioning as resi- denlial schools or homes, fully equipped for treatment of CP, mentally retarded patients, perceptual (autistic disabilities), multimodal sensory perception impairments (deaf and blind, etc.).

(5) Financial aspects

In federalistic Switzerland the financial support is given by the following institutions:

( a ) Swiss National lnsurance for Disabled; (b) National Health Scheme and allied insurance com-

(c) Cantonal contribution scheme; (d) local governments and departments of education and

environment; (e) allied foundations; (1) private associations (charity funds, various organiza-

tions, private individuals).

pan ies ;

(6) Therapy

As said before, parents fail to consult a speech and language specialist early enough. This statement calls for an answer to the following question: “When is the best moment to seek consultation ?” A baby 6-12 months old, with significantly disturbed babbling behaviour, should immediately be taken for consultation either to a speech therapist o r to an advisory or consultation centre. At that age, the following irregulari- ties may be significant and require attention: the baby does not line-up sounds (“mamamama” or “gagagag”); lack of responsive reaction when addressed in conversation; lack of reaction to sound (not turning towards some source); failure to imitate simple gestures.

As an expert on speech and perceptional development, the advising consultant has the first opportunity to observe a playing child at different situations. Without prejudice he is able to give competent advice on further steps to be taken. He recommends whether the child should be taken to a medical specialist (paediatrician, paedoaudiologist, neurologist, o r physio-psychomotor therapist) o r whether just plain practical advice and hints to the parents are sufficient at that time. Detailed knowledge of symptoms and causes of speech and/or language disorders can only be obtained through multimodal, careful observation and, if necessary, through special tests and examinations. Observation, examination, and therapy are always linked together. Therapy without careful observation has proved to be a “bottomless pit” and an “empty struggle with symptoms”. While symptom treatment is generally known to give temporary relief, it never touches the problem “at its roots”. The speech therapists in Switzer- land are trained in the first place to consider the child’s whole personality and not to commence therapy lessons until the evaluation of all tests and examinations is to hand.

In cases ofsevere impairment it may be necessary to direct the child to more than one therapy lesson a t a time. In such situations multimodal teamwork is important and necessary for correct timing and harmonization of the different therapy treatments. This is not always a n easy task, but it has been proved in the past that such maximal complex treatment leads to remarkable improvements in speech within aston- ishingly short time periods.

The methods used in Switzerland are fundamentally based on integral processes within normal speech and language development, serving as the main orientation guideline to the

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child. In this respect priorities must be set to ensure success- ful communication development while guiding the child through step-by-step procedures with structured support. The early stage ofdevelopment with children of up to 4 years of age is marked by close cooperation between the parents and the speech therapist, not neglecting the importance of family-directed activities. Ideally, in cases where therapy lessons take place in the family home, the therapist has at thc same time the opportunity to give the parents necessary advice on how to motivate and encourage the child.

In the beginning, the speech and language deviations are mostly generated by overlapping motor and cognitive disturbances in general development. One method ofhow to bring the child to the desired activities is based on Affolter’s theories (developed after studies of Piaget). This is the so-called perceptual training, which is widely practised i n Switzerland. When accurately applied, it produces excellent results.

During the training period the Swiss therapist is taught to observe carefully all changes in the child’s behaviour. Through its reaction and performance the child can indi- rectly tell where the barriers of the “possible” and “impos- sible’’ begin and end. thus giving the therapist valuable hints on the best method he can choose for his patient’s kind ol’ disability. At all times the therapist must maintain ful l stock of different methods and theories which could be applied i n accordance with the child’s needs. He also bears in mind the twoimportant ru1es:“whataniIgoingtodo with thischild?” and “why am I doing it?”

We must not forget that the Swiss therapist is literally being “surrounded” by all the different science, literature, and studies on speech therapy available in French, English. Gt‘r- man, and Italian. Undoubtedly this is an excellent position to begin with.

The findings of neuro- and psycholinguistic research arc very useful instruments in speech therapy, particularly during the school period.

In this phase, too, the speech therapist has to operate from the platform of natural development of a healthy child, and, indeed, for this reason the great majority of therapists in this country were educated and have practised as school or kindergarten teachers prior to their speech therapy studies.

As soon as the speech- and language-impaired child at school age can follow the given instructions correctly, special exercises of speech movements, grammar rules, fluency ( i n - cluding nasal-free speech), and language processing become the main objective of the therapy. At this point some details concerning the number and length oftherapy lessons in Swit- zerland might be of interest: According t o Motsch’ the average length oflesson perperson perweek is 55.6 minutes. This time is mostly spent in one or two sessions. The average time in French and Italian parts of Switzerland is about 45 niin- utes, dropping to only 30 minutes in the German-speaking part of the country. In many cases, more weekly therapy lessons would be desirable and welcome from the therapist’s point of view (two to four lessons).

The question concerning general average length ofa whole therapy is difficult to answer, for it depends on several basic facts including aetiology and the degree ofdisability. Therc- fore, therapy may consist ofone single consultation or extend to several years of exercise and training.

Conclusions

In Switzerland, speech and language therapy for children is generally known, recognized and integrated in the national

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~- SCHALC'H: Speech - language rchabilitatton for children

health \ys tem. However, by no means can the present avail- abilit) o f therapy services be described as sufficient and plen- tiful. O r u t efforts a re being made in this direction to expand and to intensity the therapy services all over the country. These e t h r - t s are hindered by many people's indifference and failure to take their children early enough for proper consultation. Zdtfilionally, many medical doctors and special education \tat'f'are not being updated on the latest information on currcni acailability ofspeech therapy services. The necessity and importance of this is much undercatimated.

Moat speech- and language-impaired children attending therap! l e w n s are i n the age range ofh-10 years. It is sug- gestecl that the hypothesis: "longer duration of treatment in cases w i t h late consultations" is being ignored. and that the old principle of"wait. let tlie child mature and do not inter- fere \ r i l l \ the natural way" strangely still prevails nowadays. H o w c \ ~ ~ . many cantonal authorities, councils, and insur-

ance companies are reluctant to carry therapy costs for children at pre-school age; even cases ofchildren a t kindergarten a re often treated in a negative manner .

Swiss speech therapists d o not work according to fixed methods. They are completely free to build LIP an individual treatment, complying with the patient's needs, based on development a n d behaviour of a normal healthy child.

The therapy costs a re shared by various institutions rang- ing from federal ofices to communa l a n d private organizations and trusts and private individuals.

The combination ofdifferent carriers a n d public interest is existent. Yet i t requires further consolidation. clcvclopment and iniprovcment, in the field ofspeech and therapy services. The therapy service must be made accessible on a larger scale. not only to children. but also to adults. Intunsiticd public information and education concerning dimension!, of verbal communication have the first priority.

References I . Mii t \ [ 11. t i . .I. S/~mc.hhr//in~lt.,.rc. i l l d ~ r .Sc./iii,c,iz. C'H-6003 Lu- 3. BIKWK. K. 1'. and SOVAK. M. Logopiiclic, Berlin: Verlag Volk

4. BKOOKSI-IIKL;. R. H. A n /n/lodicc./io/~ /o .I/I/~U.\~LI. Minneapolis: BRK Publishers ( : l ph~ i . \ i ~ [German translation]. Stuttgart and New York: Gustav Fischer Verlag, 1983).

zeiii Verlag der SchweiL. Zentralstelle l t r Heilpidagogik. und Gesundheit. 1971. 19x1

2. Scr r i i I ihci. A. .Sprrc~/- / I / / c / . ~ ~ ~ ~ ~ / ( . ~ ~ \ / ~ i ~ f ~ / i , ~ ~ , / / ( in : Hals-Nasen- Ohrcii-Hcilkunde, Bd I1/2. Stuttgart: G. Thienie Verlag. 1963; pp l l8 l~ - l25 '~ .

Book review

Disability prevention

Thia iniporlaiit hook contains the papers presented. and sunimarizcs the conc,luhions reached. at a special seminar convened at the sug- gestion ol Sir J o h n Wilson. at LeedsCastle, near Maidstone in Kent, in 1981. t<bwards the end ofThc International Year of Disabled Per- sons. 7 fiL.nt\-liw leading scientists. clinicians. administrators. and politici;in\ wcre brought together to "discuss the prospects and the means liii initiating or reinforcing action to rid the world ofprevent- able dis;tliilitich*'. to quote the words ofthe Chairmiin ofthe seminar, the Rt. tion. The Lord Home ofthe Hirsel. K T 3 DL. The various chapter..; 111 tlie hook set out estiniates ofincidence and prevalence of disabling t onditions, draw attention to known means of prevention. and dix.u\\ practical mechanisms for- providing such prevention.

I t i s e\tiniated that there are hetween 4.50 million and 500 million disabled Iwople in the world. One-third ofthese people arc children. and foui--lilihs live in developing countries. Almost lwo-thirds ofthe causesd'rlic disabilities are due 10 malnutrition. congenital and birth defects, injuries. and communicable diseases. Much ofthis burden 01' morbidit! could be prevented by the application of conventional public Iic.ilth insights. Aspects ofthis theme are \pelled out in the hook. t 01 cxnniplc, million5 ol'children suflcr froin protein-energy nialnutr-ition. 200 million persons suff'er from endemic goitre. millions friini wrophihalmia and millions froin anaemia. During the course oI'c;ich year 5 million children die and another 5 million will become cvtppled. deaf, blind, or mentally retardcd because of one or other 01 ?I\ diseases which can be prevented by immunization (neo- natal teiiliiiib. polioniyelitis, ineasles. pertussis. diphtheria. and tu- berculo>isl A priority, therefore. is the development of community participaliim. nicaning the involvement of thc inen and womcn in local arcas i n the understanding and solution oftheir problems. and the impro\cmcnt oftheir, and thcir children's. lives. .As important as this aspeci IS, the options open to individuals and local coniniunitieh may be ~ c t i'rely restricted by adverse environmental. financial. and

social constraints which can only be changed by government. Some- what similar considerations apply in industrial socicties. where chronic diseases are the major contributing causes to disablement. ticre too. although in different ways, sonic of which arc little undcr- stood, a large part of the difficulties i s intimately related to the structure and values of society.

The group summarized their conclusions and recommendations in a statement: "The Leeds Castle Declaration on the Prevention of Disablenient"(seeInr. RPIIN~I'I. .Wid.. 1983: 5:l) . This statement has already had an impact on international organizations. particularly the United Nations General Assembly. U N Centre for Social Devcl- opinent and Humanitarian Affairs, WHO. UNICEF, and IJNDP. The last three organizations have set up an administrative uni t to assist with the promotion ofaction for the prevention ofdisablement, particularly within the national programmes of developing countries. Thc clarion call ofthe seminar i s succinctly put in the following words in the final chapter:

the message ofthe seminar, elaborated in this book, is that disablement with all its consequences of wasted resources and frustrated lives need not necessarily be an inescapable part of tlie human predicament. Prevention on an unprecedented scale and at no great cost is one ofthe options available to the international community during the next twenty years.

Success in this endeavour requires the exercise of political will. the allocation of resources (moderate by standards of current expendi- tures) by national governments and the organization. inspiration and motivation of a multitude of local communities of many different cultures and social structures in the developing and the industrial- ized countries. The actions started in the IYDP must be continued and developed. This book i s a source of inspiration; its message, so clearly set out. impels conviction.

The book should be widely read by everyone conccriied with the mitigation of disabilities and handicaps, and they should bring it to the attention of administrators and politicians.

Mi( . t iAi . . i . WARRVN

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Documents

Speech - Language rehabilitation for children in Switzerland