Speech & Language Therapy in Practice, Spring 1998

7/28/2019 Speech & Language Therapy in Practice, Spring 1998

1/32A posit ive approach for committed professionals .


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The bigbreakthroughon a smallscale

The new DynaMyte is a lightweight,capabilities which introduces a new dimension toaugmentative communication by offering greaterfreedom to the ambulant user.advanced communication capabilities, and uses the same software. A built-in

remote control unit allows the user toaccess computers and other household appliances, and it

portable device with powerful communication

DynaMyte is just half the size of DynaVox 2 and yet it retains all its

The DynaVox 2 features a system of alarms capable of performing a varietyaugmentativecommunication aid of preset tasks. A clear, easy to operate touch displayhas introduced a provides access to the full range of DynaMyte'snew era of freedom to communication power. Its long life battery and durable,people of all ages whohave speech disabilities. rubberised casing guarantees easy to carry communicationfo r people of all ages with speech disabilities.

DynaMyte is a natural product extension from theadvanced DynaVox 2 communication device whichsuccessfully enables many users with mobility impairment todevelop a greater sense of self expression andindependence.

For full information and demonstration, contactDYNAMIC DYNAMIC ABILITIES LTDA ~IM IT E D THE COACH HOUSE, 134 PUREWELLCHRISTCHURCH, DORSET BH23 1EUTELEPHONE : 01202 481818~ ~ FAX: 01 202 476688


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SPRING 1998(publication date 23rd February)ISSN 1368-2105Published by:Avril Nico llLynwood CottageHigh StreetDrumlithieStonehavenAB393YZTel /fax 01569 740348e-mail [email protected] Production:Fiona ReidFiona Reid DesignStraitbraes FarmSt. CyrusMontrosePrinting:Manor Group LtdUnit 7, Edison RoadHighfield Industrial EstateHampden ParkEast bourneEast Sussex BN23 6PT.Editor:Avril Nicoll RegMRCSLTSubscriptions and advertising:Tel / fax 01569 740348

Avril Nicoll 1997Contents of Speech & LanguageTherap y in Practice r e ~ e c t the viewsof the individual authors and notnecessarily the views of the publish-er. Publication of advertisements isnot an endorsement of the adver-tiser or product or service offered.

Cover picture:qnical Teaching with video

C O N T E N T S ~ ~News/ Reviews 17Comment 2 Counselling, dyslexia, pragmatics,autism, conversation analysis,voice, language disorder, childlanguage, general treatment.What docarers think? 4 Reader Offer 20Penny Hodgkinsoncarries out Review one, get one free,exploratory courtesy of Winslowresearch into carerattitudes towardsthe communication COVER STORY

of adults withlearning disabilities. Clinical Teaching 21Julie Marshall andCatherine Aldred's9 observations on asupplementary learningCounselliog paCkage using video.Personal Construct Psychology How I ...

Sasha Bemrose and Malcolm Crossmanage my 24utline techniques of PCP using case examples from their innovative work caseloadwith parents of deaf children .

13Teams from adultneurology, community paediatricand learning disability fieldsGroup' ~ e r a p y @ sharetheirexperiences.for a p ' ~ a s l a - e c ~ r: : : >a positive - G - MyTop -

outcome 8 Resources 30Group therapy has ~ - ~ u-"become a popular choice Heather Tayloras an adjunct to individual , lists the ten itemswork with people with ! she could not doaphasia. Caroline without in herDavidson and Carol ~ work w i t ~Nelson ask if it can be '" ,> people Witheffective in its own right.


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NEW S & COMMENT

Developing new skills Group therapy has become a popular caseloadmanagement tool for speech and language therapists withmany client groups. Ann Adams and her team holdcentralised groups, many on an ad hoc basis according toneed. These have the added advantage of encouragingtherapists to work together, and the way their Parent andToddler group in particular is run shows much imagination.Caroline Davidson and Carol Nelson recognise a hazard ofgroup therapy in that individuals can end up being dealtwith sequentially - essentially receiving "inefficient individualtherapy within a group setting" They have discovered theunique benefits of gathering people together and preparingtasks which give the opportunity for debate and discussionaround the specific linguistic needs of the members. Grouptherapy can be very rewarding for therapists as well asparticipants but we need to prepare thoroughly and use itwisely.Working to change the communication behaviour ofparents and carers is also often touted as an efficient wayof working, yet therapists frequently complain that adviceis not followed. Perhaps in general we lack the particularskills needed to work in this way. Sasha Bemrose andMalcolm Cross believe Personal Construct Psychology hasallowed them "to discover how parents see things, if andwhy there is a need for change and within what parametersthis change can come about. Without this understanding,any intervention focusing on change is likely to fail. "Perhaps, then, we also make too many assumptions aboutwhat others think. Penny Hodgkinson has exploredattitudes of carers and in the process discovered how tochange her practice to enable carers to make thechanges she wants to see; she now offers more detailedassessment, demonstration of techniques in everydaysettings and training relating to an individual client.We are encouraged to offer training in a bid to spreadexpertise and make therapy more efficient but we needparticular skills to provide it to the required standard.Therapists need more information about adult learningtheory and how to exploit new technology for trainingpurposes. Julie Marshall and Catherine Aldred have done justthat with their supplementary video teaching packagewhich could also be of use to practising therapists lookingto update their knowledge of a particular field.Part of a therapist's skill comes with experience. Thismonth's My Top Resources shows how this constantly refineswhat we offer clients. Some readers, when asked to contribute to the How I .. section in particular, feel reluctantprecisely because what they do evolvesand, as Ann Adams tells me, becausethey already know what they do and

want to know what other people dowhen faced with the same problem.However, I need to hear about runninggroups, managing caseloads, work ingwith parents / carers, teaching or anyother area of our work so we all havethe opportunity to develop the skillswhich will benefit our clients.

Avril NicollEditor

Lynwood Cottage, High Street, DrumlithieStonehaven AB39 3YZtel/ansa /fax 01569 740348e-mail [email protected]

ADA bidsuccessful EAction for DysphasicAdults has secured _ _ _ _ _ AssociationLottery funding tocoT/tinue its regional Stroke unit callThe Stroke Association is lobbyingParllilmenl to demand lhac alldevelapmem work.The charity also people wh o have hlld a s rake arefeatures as The treated in a stroke unit, no malWeek's Good Cause ter where tiley liv e.011 Radio 4 on 22 nd This follows previous researchFebruary. showing that, for every 22 Recent work of the patients treated, one extra patientcharity includes is likely to suruive if trellted in aencouraging strohe unit ralher than in a coulISellors to leant conventional selling and, for more about warhing every 16 patients trea ted, oneex tra patient would regainwith people with independence. in II 1995 swdydysphasia. funded by the Stroke Asso ci(1lion,ADA will send out less than half of the consultan tsleaflets and posters surveyed had access to a to anyane holding II speciillised strO/le rehabilitation unit.fund-raising event. The Association continues to ADA: tel. 0171 261 fund research, including a recentaward to City University, London

to test ways of helping peoplewith Jargo n dysphasuz9572.

Workolace develop functionalfunding writing skills.The latest In the Slgnalong at Work The Strokeseries, General Re ta il. rna be the last if Association: tel.furth er fundi ng cannot be found. 0171 490 7999.A lone ry grant 10 uppo rt the signingvocabulary developments i a l an end and Cancerthe chari i asJ,.;ng us r I consider

contributing on pound a month. pleaMeanwh ile, phases 1 - 3 of the Bas ic Macmillanocabula ry are available in symbol Cancer Relief isform from Widgit Software LId on looking fortheir Rebus 4 . individuals andDetails: 01926 885303. groups to takepart in itsMacmillan MilesVolunteers needed event.Sponsors pledgeVolunteer field workers are one pound toreq ui red to work on a range of participants forprojects for Trek-Aid. covering a mile.The sma ll cha rity helps Tibellln often in imaginativerefugees in India and Nepal. ways, all moneySpecialist skills such as medicine, raised goingdentistry, nursing, midwifery and towards helpingopthalmology are especially lIalu someone who hasable, but enthusiasm and com mit cancer. The charityment are often needed as mu ch as funds specialisttransferab le skills. The volunteer Macmillan nursesing is on a sma ll scale where peo and doctors,ple ca n learn from and interact buildings for cancerwith Tib etans. treatment and careSpeech and la ngu age therapist and grants forJudith Mitchell is going to Nepal patients in financialwi th '[j-elz-Aid for three months difficulties.from March 1998. She wlll be The event runsworking on several projects from 9th to 17thincluding assisting in the estab May 1998. To takelishment of a dental clinic, a part. call 01372vocational training scheme and a 450070 .health education programme.Details: send a lmse SAE to Macmillaf8TREK-AID, 2 Somerset Cottages, L-___________ancer reliefSto l1e Villag e, Plymouth PL3 4A2.

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 1998
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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NEWS

Prevent the wasteThe British Dyslexia Association claims there is widespread andunacceptable tolerance of underachievement.

A national survey of LEA SEN policies suggests children oftendon't start to get the right so n of help until they are falling at

least four years behind. The BDA believes the Code of Practice for identifyingand assessing special educational needs should be implemented systematically across

the counuy and that specialist support should be available before a child falls so far behind.A recent campaign therefore focused on the positive steps that can be taken for early identifica-tion and support. Activities of 'Stop the con.flict, prevent the waste' included booklets in Bootsstores and the launch of a BBC Education / BDA Teaching Today Pack for primalY school teach-ers. In addition, a new Early [ntelVention Project run jointly with AFASIC has staned. Designedwith the help of the Department of Human Communication Science at UCL and sponsored byGI


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LEARNINC DISABILITY

Communication in ALD -What do carers thinl


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LEARNING D ISAIl ILlTY

Rgure I - Principles ofServiceDelivery (CommunicatingQuality 2)"The active role ofcarers is seen as essential,with therapists positivelysupporting theirinvolvement'"Building an environmentthat is conducive to goodcommunication isparticularly significant tothis client group. It isrecognised that developingimproved physicalsurroundings, personalcircumstances andappropriate communicationused by carers willsignificantly benefit theclient'scommunicativesuccess. These shouldalways be regarded as aprimary focus forintervention:'Indeed, if carers are notable"to adopt and effectthe necessary change forgoals to be achieved",thenthis may act as a trigger fordischarge.

resea rch from applied linguistics has provided useful models (Nunan, 1992).Assessmen t should be comprehensive andinclude both naturalistic an d more formalcon trived communication and languagetasks foc using on specific skills. It shou lda lso link into the specific nature of theclient's learning di sa bility a nd takeaccoun t of th i s. The tim e implication maybe considerabl e. Jvly ow n wo rking practicehas adapted and the assessment phase mayrun into several sessio ns for o ne client inva riou s se ttings.The speech an d language therapist actsa lso as a so urce of informa tion for carersregarding medical aspects, individual syndromes and their associated disorders, sen

:........................................... .. ,., ....... ....................................................................................... Theme I - Individual skill / individual difficultiestMost people communicate somehow in their way'The speech and language therapist was expected tostart from the client and their specific skill set in any review of communication skills.

~ e r e was recognition amongst staff that lack of speechdid not preclude communication skHls. Speech, whilstpowerful, is not the only communication method andstdff were tuned into this. Intelligibility in articulation wasnot highly rated as a communication skill, but staff dididentify it should be considered in comprehensivea s s ~ s m e n t , and clear reasons be given for not workingon It.Staff felt professionals like speech and language therapistsshould be in a position to provide detailed infolmationabout factors associated with specific syndromes. such asphysical and sensory deficits. They also perceived we areable to access other services such as screening forhearing and vision more readily, perhaps because we arealso employed by health. Staff generally felt hungry forinformation and knowledge about what can be expectedin terms of individual skills / deficits with differentdisabilities. There can be startlingly low levels ofknowledge about relatively common disabilities such asDown's syndrome. This was found even in professionalstaff who have many years of experience working withpeople with learning disabilities.A a ~ k .of social s k ~ l I s ~ identified as the most disablingdefiCit In commumcauon and marking people out aslearning disabled in the wider community. Other factorsconsidered important were individual client languageskills (particularly specific areas of vocabulary such thelanguage of emotion). There was recognition thatindividual inabilities can lead to frustration and so-calledchallenging behaviour. Challenging behaviour wasgenerally viewed as communication in another form.sory im pairme nts and the impact Ihese Combine the besthave on com munication. The views of carers and in particular theirThe role of the therapist as a consultant attributions as to the causes of specificrather Ihat hands-on clinician with Ihis communica ti o I1 breakdown, and thereforeclien t group is no t as c1ear-cllt as some ser th e potent ia l for change, need to bevice del ivery models suggest. as there is a exp lo red before any therapeutic process isneed for me to demonstrate by my own underta ken. Wh ilst training achievescommunication behaviour with clients much in raising awareness of communicahow staff sho uld com muni cate. There is tion d ifficulties in general. it may no t gostill a need to focus o n indivi dual sk ills fa r enough in changing speci fic behavioursand needs w ithin the context of th e overa ll with individ ual clients. For Ihis to comelearn ing disability, and to relay th a t assess about, we need 10 combine the best from thement information to staff. There is a lso th e consultat ive model and Ihe less fashio nableneed to focus on the partnership element but neverIheless sti ll va lid Iherapist ro le.in comm un ication and the research by Penny l-fodg/limon is Specialist Speedl and U u l ~De ll a Money, the Over and Ou t package, Therapist - AIiu/t Learning Oisabilili e> Sen>ice uoirhrepresents a step forward in this area. Mid-Arzgljo Commllnit)' (NHS) Hetlltii TTI/Sl.

SPEEC H & L.ANCUt\GE THERAPY IN PRr\CfI E SPRIJ G 1998 5


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I.EAR IN G D ISABILITY

Theme 2 - Environmental fadorsWe have no idea how to tap in'The staff inte rviewed were conscious of their role inpromoting communication and of the inflexibility ofsome of their organisations and settings. Some felttheir days were so busy (organising IndividualProgram Plansor other planning meetings,arrangingtransport, fi lling days with meaningful act ivities,covering staff shortages), it was som etimes hard tobe sensitive to com munication methods which aredifferent N ew staff coming in need to be madeaware of specific individu al communication needs,not always easy to accom plish. Staff felt theysometimes lack the "breathing space" to createoppo rtunities within the routines / constraints oftheir organisation.They often relied heavily on

assumptions about communication abilities, bothover and under estimating skills and situations. It wasrecognised however this was within th eir sphere ofinfluence - it is "our shortfall and our responsibility".Staff accepted their role in adapting environments topromote communication but also commented thegenerally limited life experiences of clients maycontribute to limited opportunities overall forcommunication.The impression was one of de-skilling, a kind ofpowerlessness in their ability to bring about changein their own workplace and a sense of failure.Speech and language therapists were felt to have arole to play in empowering and acting as arole-model for staff. Showing staff how to "tap in",and demonstrating regularly and in context thecommunication skills which were important washighly rated rather than telling staff how tocommunicate.

Refere nc es Glase r, B. and Strauss, A. (1967) The Discovery o f Grounded Theory. Chicago: Aldi ne. Hurst-Brown, L. and Keens, A. (1990) ENABL E: Enab ling a Natural and Better kifestyl e. London: Fo rum Co nsul ta ncy. Jones, S. (1990) INTECOM; A package designed to integrate carers into assessing and developing th e com mu n ication skills of people with learning difficulties . Windsor: NFER-Nelson. Money, D. (1997) A compari son of three approaches to de .livering a speech and language therapy service to peo p le wi th learning disabi I ti es. European Journal of Disorders of Communication 32 (4). Nunan, D. (1992) Research Methods in

Language Learning. Cambridge:Cambridge Uni versity Press.Pahl, J. (1992) Force fo r Change o rOp ti o nal Extra? The impac t of research onpo li cy in social work and social welfare. InCaner et al - Chang ing Social Work andWelfare. OU Press.RCS LT (1996) Co m municating Qua li ty 2.London: Roya l Co llege of Speech andLanguage Therapists.Stevens, L. (19 93) Reflexivity: recognis ingsubj ectivity in resea rch. In Health Researchin Practice (eds Co lquhoun, D. andKellehear, A.) Lo nd on: Chapman and Ha ll.Strauss, A. L. (1987) Qualitative Analysisfor Social Scientists. Cambr idge:Cambridge Uni ve rsity Press.Thu rman, S. an d Money, D. (1996)

Theme 3 -AssessmenttechniquesThe common theme wastime; staff felt taking time toget to know the client andtheir different communicativecontexts was crucial.Assessment should take placein every context - home, dayservice, residential care. Stafffelt speech and l a n g u ~ etherapists needed to De withindiviauals and groups notjust to observebut toparticipate. They foundcheckJlsts and interviewschedules difficult to fill in,aJthough they didn't object tospeed\ and language t h e ~ ystaff filling them in with them.There was somedisagreement as to whetherthe therapist should rely oncarer reports or shouldassess dlrectJy. Many staffwanted the speech andlanguage therapist to beactively and directJy involvedand not to rely on carerreports / observations.Others recognised theimpact on resources thiscould cause.

Talkabout. No ttingham Commun ity(NHS) Trust.van der Gaag, A. (1989) The view fromWa lter's window; socia l env ironment andthe communicative compe tence of adultswit h a mental hand icap. JOllrnal of MentalDeficiency Research 33, 221-7 .van der Gaag, A. an d Dormandy, K.(19 94) Commu nication and Adults withLearning Disabilities. London : Whurr.Whyte, D. (1992) A family nursing Approachto the care of a Child with a chronic illness.JOllrnal ofAdvanced Nursing 17.Th e Summe r '98 issue will feature anapproach to changing the communica-tion behaviour of carers for adults withlearning di sa bilities.

SPEECH & LANGUACE THE RAPY IN PRAGrICE SPRINC 1998

I I


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LEARNING DISABILrJl'

Theme 5 - StafftrainingThis was perhaps the mostcontentious area of staffperceptions. Many hadTheme 4 - Inte fYention attended workshops onStaff felt strongly that intervention for improving issues around communicationcommunication should take place via care staff. It but felt unable to translateshould be consistent across all contexts as far as this into practice; in generalpossible and time frames should be built in. staff training was viewed asTherapists should supervise in a han ds -on capacity unlikely to achieve change in

with care staff in situ to model and demonstrate the behaviour:strategies to be used. Alte rnative and augmentative Training should be tailored tocommunication (AAC) should be taught to all care individual cases, in-house andstaff before it is introduced to the client and signing more ongoing than one andtraining sessions w hich are not based around two day more theoreticaJindividual client needs are unlikely to work. Staff workshops.To bring aboutwant to be told w hat to say and do by the therapist change, staff wanted specificin the communicative situations as they arise, one examples of what to do andsaying " Put the words into our mouths". Again this what not to do.has implications for the "hands-on" versus consultativerole of the speech and language therapistCommunication is such a context bound behaviour

that sometimes being on the spot can provideopportunities for commenting on staff behaviour.

1FIiT"'____-... ..... ..... .............. ............. .......... ........... .. . .............. .

should use the best elements of the consultative and hands-on rolesiIC7..... .. .. . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . ..... . .... . ... .. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . .. .... . . . . . . .. . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .

,.......................................................... .......... ....... .. ... .................. ........... ... .............. .......... .......... ..................................................................... and language therapists are expected to provide detailed informationIndividual 's aisability as well as communication strengths and needs.

4. Poor soc ial skills and specific areas of vocabulary mark people out as differentand should therefore be considered for therapy; clear reasons should be given ifarticulation skills are not targeted.=. ; sts should participate in daily activities so they can empower staff by T"'j'

1,_, , them approp riate communication methods regularly and in context.6. Training shou ld be in house, ongoing and tailored to individual cases, providing speci fic examples of what to do and what not to do. Care staff should be taugnt AAC before It is introduced to the client. .

:;:;",il udes anq p e r c ~ p t i o n s of carers have tc? be taken into account w hen ., '.-,Y change In their communication behaViour and Improving service deliver y.JL'- . . . . .

SPEE CH & u\NCUACETHERAPY IN PRACTICE SPRIN % 7
http:///reader/full/workshops.Tohttp:///reader/full/workshops.To


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RESOURCE UPDATE. . . CE UPDATE.. . .RESOURCE UPDATE._

NEWS & RESOURC ES

o~ .i h ~ - \ojRN I B

challenging hlindness

Visuallyimpaired at risk The Royal National

Institute for the Blind isslamming communitycare for people with a

visual impairment.It contends all newlyreferred people with apermanent and substan-tial sight loss arc at

immediate risk an dshould be considered as'disabled'. This should

trigger a full communitycare assessment to takeinto account other relevant social, medical an denvironmental factorswhich, combined withvisual impairment, can

increase the likelihood ofrisk leading to accident.A Questioll of Risll (free),RNIH Crl.'tomer Serrtices,tel. 034.5 023 153.

Realising possibilitiesA research speech and language therapist has co-authored a book highlighting communication problems. Sarah Barnett collaborated with Professor Sheila Hollins, Professor of Psychiatry of Learning Disabilities, to produce Mi chelle Finds a Voice, the story of a young girl who tries to describe the theft of her handbag to her family and the police using a very limited and outdated language / sign chart. The book is the fourteenth in a series designed to help healthcare professionals and families realise the possibilities of communica-tion. Professor Hollins says "even professionals such as doctors, therapists, psychologists and carers fail the 'MichellI'S' of this world by denying them access to alternative and augmentative communi-cation systems," From: Royal College of Psychiatrists, tel. 0171 2352351 exU 46, price flO.

Teletubbies in good voiceCoaching was provided to the actors on the BBC's Teletubbiesto help the mature actors adopt the range of a child's voice.

Roz Comins of the Voice CareNetwork carried out routinevoice work with the charactersincluding exercises for warmup and to explore and findappropriate voice quality.A range of groups now recognise the value of voice coaching, including magistrates andkeep fit instructors, and theparticular needs of physicaleducation and swimmingteachers were explored at the Network's third Annual Study Meeting. Also included was discussion about classroom amplification. The Voice Care Network runs practical interactive study days, The next Annual Study Day will be in Birmingham from 6 - 7 September. For details, contact Roz Comins, tel. 01926864000,

South AfricandevelopmentA specialist medicalreCTllitment colllpan)' in theUK has opel1ed a SouthAfrican office.Healthcall Euromed aims tomahe the inteTllational moveof professionals, includingspeech and language therapis15,easier. The company reCTlli15and places staff 011 a locumand permanent basis.Details: Leslie Giltz, tel. 01712870880.

Schools Liaison-timeSchools LiaisonOfficer to help

the 100 000school aged childrenill tire UK who stammer.Chen,), Hughes, who stmnmersIrenel! has coll5iderableexperience in education. Shewill be il1itiating a pilot schemeof in-service teacher trainillgwiLlI tire assistance of localspeech and language therapists.Other duties will includehelping pupils with oral worhand dealing with issues ofbullying and careers guidance.Details: BSA, tel. 0181 983 1003.The BSA now has a website:www.stammer.demon.co.uh

Rhyme resourcesA nursery rhyme activities bookhas been added to Scholastic'sstarting with rhyme series.Counting rhyme and Actionrhyme activities are alsoavailable fo r use with childrenaged three to six and arephotocopiable.From: Scholastic, tel. 01926816216.

Textphone helpRoyal Mail has installedspecially designed textphones at_ .,. customer help

centres for deafand hard ofhearing customers. Staffhave been trained by the RoyalNational Institute for the Deaf.Royal Mail Textphone calls:Customer SelVice 0845 600 0606Sales 0845 600 6066Address Management0845 606 0604.

PGSS on filmA new video, Paget Gorman SignedSpeech: The Filmed Vocabulary,contains over 4000 signs jrom the7th edition oj the manual.Eight cassettes each run jo rapproximately two hours:Vol. 1Standard Hand PosturesBasic Signs with all their related signsANIMAL - FLOWERVols 2 -4 Basic Signs as above, FOOD -PLANT, PERSON - SURFACE andSUBSTANCE - WATERrespectively.Vol. 3 includes Prepositions.Vol. 5 Nouns in categories (eg. Clothes,Household, Family)Vol. 6 Miscellaneous Nouns, Pronouns,Adverbs, Conjunctions, Questions, BODY &SENSATION hand signs.Vol. 7 VerbsVol. 8 Adjectives, Determiners, Number,Mathematics, Measurement, Calendar Time.Cost: 90.00 per set oj eight tapes piUS p&p oj5.75.Orders with payment to: The Paget GormanSociety, 3 Gipsy Lane, Headington, Oxjord OX37PT Tel. 07865767908. The Society now has acomprehensivesite on the Internet:http://wwwpgss.orgl

Stammeringfor spousesA new leafletgives partnersand spouses ofpeople whostammerinformation

......__ - - - . ; ~ a n dguidanceabout how to help.The British StammeringAssociation leafletexplains how someone who stammers who undertakes therapy may discovera new assertiveness, reveal vulnerabilitiesfor the first time, or begin to express feelings such as anger that they have tended tobottle up. It encourages couples to talk toeach other about stammering.Author Sarah-Jane Wren is assessing thelevel of interest there would be in a coursefor spouses and partners of stammerers atthe City Lit. (tel. 0171 242 0224).Cost: sOp per copy or 4 for ten (inc. pap)from BSA, 15 Old Ford Road, London E2 gpJ.

8 SP EECH & lANGUAG ETIIERAPY IN PRAGrIGE SPRING 1998
http:///reader/full/www.stammer.demon.co.uhhttp://wwwpgss.orgl/http:///reader/full/www.stammer.demon.co.uhhttp://wwwpgss.orgl/


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COU SE LL! C

orl


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COUNSELLING

Carol has a onean.d a half yearold daughter

This method was usedwith Sarah who has a three yearold son with a profound hearing loss. Shehad vague concerns about herself as a parentand triadic elicitation helped explore the dimensionsshe used to make sense of parenting.This was achievedby asking Sarah to think of a number of parents she knew.These parent figures included herself as she is now, as she wasbefore she became a parent, as she would like to be as a parent,her parents, parents she admires and does not admire and so forth.The therapist asked Sarah to choose three names at random and sayhow two of them were similar (circled below) and different from the third.

Elements/People ~ Me ~ My MumConstruct

. ,'need to beIn control' vs 'relaxed'who has a mod-erate hearingloss. Carol said

she felt herdaughter did nottalk and therefore she was notable to interactwith her. In thisnstance 'does not

One of the dimensions Sarah identified which she used to make sense of parenting was 'in control' versus 'relaxed'. She felt she needed to be in controlbut would like to be more easy going. The articulation of this constructhelped Sarah discover she did not have to be only 'in control' or 'relaxed'but rather that different poles of the construct could apply at differenttimes. It enabled he r to see ways of being more like the kind of parentshe wished to be. She identtfied aspects of parenting where she couldbe more easy going (during play sessions with her son) and sometimes where It was he lpful for her to continue to be in control(when disciplining h e l ~ son). After a few weeks Sarah reportedshe felt more confident as a parent and was enjoying the timeshe spent with hp r:...cl}n, attributing this to her new insights.

talk' was the emergent pole. She felt theopposite of not talkingwas 'saying words'. Fromthis elicitation the therapistand Carol discussed nonverbal aspects of herdaughters communication,ego pointing, vocalising, eyecontact. Following this discussion she became moreaware of her daughter'sattempts at communicatingand began to accept theseas 'talking'. From thisreconstruction she wasthen able to begin theprocess of more effectivelyInteracting with her child.

in the past by be ing push y. then we are likely to use this strategy againin the future. Constructs are unique and therefore we expect people to make sense of the same events different ly Perso nal ConslnJctTheory suggests we use particular constructs to make sense of afinite range of events.Most importantly, personal construas are hiel-archical, that is, some are More important than others.ExplorationWhen uSing PCP w ith parents of deaf children, the personal constructs chosen for exploration are those defined by the parent asproblematic or collaboratlvely ide nti fi ed by all part ies as Inh ibitingchange in the desired direction.Constructs may be eli crted in a variety of ways including informal and triadic. Further tech niques of ad dering cl.nd pyramiding can be used to probe personal perspectives.

10 SPEECH & U\ NG Ut\GE TH ERAPY IN PRACfICE SPRING 1998

I)Informol Eliciting (Dolton &Dunnett, 1992) (Case I)By listening to the w ay the parent talks about par t icular issu es, thetherapist can bu ild up a picture of how they view their situat ion.For example, the pal-ent may say "rt's hard work looking after adeaf d llld" .W e can infer the parent has a construct about lookingafter the ir- child; hard work' versus something el se. In this instanc e'hard work ' is tne emergent pole. The therapist can t hen ask whatIt w ould be like looking after the child if It was not 'ha rd wor k' .W emar Lhen find the construct is 'hard work' ve l-sus 'enioyable'.2) Iriodic Elicitation (Dolton &Dunnett, 1992) (Case 2)ThiS is a more formal method of el iciti ng constructs. It exp lores aperson's dimensions 01- const l-ucts rn some detail and is particularly useful when a person finds it difficult to identi fy or expresstheir constructs.


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COUNSELLING

threeLaddering has a two year old son who has a mild hearing 10ss.The therapist had observed tended to control any interactions with her son .Th is was not helpful in facilitathis communication development as it did not allow any chance for him to initiate or in tum minimised opportunities and incentives for him to learn for himself. sessions had been spent discussing this wit h Frances but a change in her interacon style had not been evident. She reported it was important for her to do everything r her son . Using laddering we wet-e able to ident ify why t his was so. The tick reprethe pole of the new superordinate construct which Fran ces prefers

.I 'good pa rent' vs 'bad parent'A. I 'feel competen t' vs feol I.l_ less'A. I 'it's my I role' vs ''la.'e n roeA. I 'do evel-ythi ng for vs '!etting my d domy child' things for h (identified the opposite of doing v e r y t for her son was 'letting my child do for himself .The preferTed pole is 'do everything for my child' and thiS as Impor-for her because it gave het- a role. She preferred to have 'a role' because she needto 'feel competent' as this made her a 'good parent' (superordinate construct). If she. . . . . . . . . son do things on his own, she would no longer have a role and feel use less and, implication, a bad pat-ent. was therefot-e vital to understand why this construct was important for Frances as, therapy focused on encouraging Frances to let her ch ild become more indepenshe was resistant to change because this meant, for her, being a 'bad parent'. ) Pyramiding was asked to think of different ways she could be a good parent.

. . ------- 'good parent' ---------..'meet child's needs ' 'teach *ew skills ' 'provide opportu nities to learn'

identified she could be a good parent in a nu mber of ways; by helping her sonvelop and leam, by teaching him new skills and by looking after his needs. From this,discussed how being a good parent could mean let ting her son be more indepenas it enabled him to grow and learn new skills. O nce Frances recognised she wasgood pat-ent if she let her son experiment with new skills, she was able to changea way which increased het- child's learning opportunities while still enabling her to actshe felt a 'good pat-ent' should.

3. Loddering (Cose 30)Laddenng can be used to explore why people make certain choices, why they I-esist chan ge or are greatly upset by what app ea r. fromo r'perspective. t o be 'minor even ts'The techni que is ba sed on theIdea that some personal constructs are more Important (superordinate) than other constructs (subordinate).This proced ure beginsby identifying a construct of interest and it sopposite pole ( Ist leve l).The parent identifies wh ich of the two po les they prefer and whythis is important for them (2nd leve l). The opposite of this secondpo le is Identified and the preferred po le chose n. Th iS process isrepea ted until the pa rent can no longe r think of a new constnuct.4.Pyramiding (Cose 3b)This is the reverse of ladder ing. O nce superordinate const ructshave been discovered we can use pyramiding to make the im pl i

cations of a part icular construct concrete . Py ramiding is facilitatedby ask ing "how)" questions.Facilitatin2 changeThe techn iques


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COUNSELUNC

leam for himself and in doing so he bec ame mO I-e Independen tThe outcome of her child being more independent was examinedin terms of our predictions (the ch ild is more communicative). Inthis example our pred ict ions were correct, which reinforces thechange the parent has brought about.PCP can be used by therapists to work effectively with parents ofdeaf children and also a variety of other client groups. We feel it isessential to have an understanding of the philosophy and theorybehind PCP and have only provided a rudimentary introduction. Ifthe speech and language therapist, like George Kelly, is not interested in the truth or falsehood of a person's view but simply in theways in which they view themselves and their relationship withothers, then they may be freer In their interpretations.Sosha 8emrose is 0 Spec ialist Speech & La nguage Therap ist ,,11mCamden & islington Communi ty Health Services NHS Trust. MalcolmC Cross is bosed In the Department of Psychology, School of SociolSciences, City University.

Any correspondence should be addressed to Sasha o[ 464 A HomseyRood. London N 19 'lEE (tel. 0 171 281 2562 evenings).ReferencesBannistec D. & Fransella, F. (1986) Enquiring Man (3rd Ed il lon). London: Croom Helm. Dalton, P & Dun nett, G. (1992) A psychology fo r living: Perso nal construct theory for professionals and clients. Chichester: John Wiley & Sons. Kelly, GA (1955 /1 99 I) The psychology of personal construct. Volumes One & Two: Norton. Reprinted in London by Routledge in 1991. For the purposes of r.his ortlcle the parents' nomes hove been changed ,PCP Training CoursesCounsel ling Psychology Research & Training Centre12 O nslow Gardens, South Croyden, Surrey CR2 9ABTel 0181 239 6947

This article is th e second in a short series looking at ho w speech and language therapists have used training in otherfields to assist their work. Neuro Linguistic Programming - A speech & language therapist's guide was in Winter 97.A personal view of counselling by Christina Shewell and FamilyTherapy will feature in future issues.

QuestionsWhat is the basis of PCP holds that each individual has a unique view ofPersonal Construct he world, under constant revision in response toPsychology?~ M . f ; I ~ ~ ~ e d b a c k received and their interpretation of it.

Why might intervention Because change is dependent on the unique view of~ M.lMtII he individual concerned, barriers to change may bef a parent / childinteraction model fail? missed if a therapist makes assumptions about howparent sees the situation.How can a speech and .. rough PCP a parent can see one view does not nec-1 ! . I ~ s s a r i l y preclude another, and that a range of optionsanguage therapist usePCP? is open to them.

RESOURCE UPDATE. . .RESOURCE UPDATE. _.RESOURCE UP DAT E . AAC developmentA new speech output device is available from Liberator,combining pawerful language with dynamic screen technology.Vanguard gives simultaneous access ta everyday words as

Helping teachersA speech and language therapy service to mainstream schools haspublished two practical guides to running language groups in schools.The West Sussex team responded to requests for more practicaladvice to help teachers meet the needs of the increasing numbers of

weI! as those needed in speCific situations. Using icons and J....... . , ~ ~Single-meaning pictures, most words can be selected withtwo activations. Pre-loaded words, songs, books andactivities reduce the need fo r programming, but this can

children in mainstream schools with aspeech and language impairment. Theguides are intended to provide teachers

. be accomplished quickly.The synthesised and digitised speech can be accessed bytOUCh, headpointing or switch-activated scanning. Built-ininfrared capabilities provide cantrol Of appliances such asa television or video recorder.The Prentke Romich Company device uses Unity andLanguage Learning and Living vocabulary programs.Details: Liberator, tel. 08004582288.

,_ and teaching assistants with a framework to run language groups.(Note: The guides will be reviewed in alater issue of the magazine.)Practical Guide to Running LanguageGroups in Schools - Key Stage 1 a 2and Key Stage 2 a 3 are availablefrom The Speech a LanguageTherapy Service, Worthing PriorityCare NHS Trust, The Satellite Centre,

Shoreham First School, VictoriaRoad, Shoreham, West SussexBN43 5WR. 15.00 piUS 1 papeach.

12 SPEECf-1 & LANGUACE THERAPY IN PRACTICE SPRINC 1998


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APHASIA

Group . ~ r a p y - apOSItIve outcome

-- NHS TRUST -In recent years, larger

caseloads and timelimitations have

made group therapya popular choice inaphasia treatmentHowever to sometherapists it is stillcontroversial, with

many using it onlyas an adjunct to

individual treatmentCaroline Davidsonand Carol Nelson ask

i fa group approachcan be effective in its

own right

s members of a busy department in an acutegeneral hospitaL we felt a group treatmentapproach for people with aphasia had a lot tooffer and was not being used to its full potential. Although clients seemed to have benefit-ed from previous groups, we had never for-mally evaluated outcomes. We therefore con-

ducted a small study using clients attending individual therapywh o had plateaued. We asked if they would be interested in attending a group to see if any further gains could be made. The five,whose ages ranged from 54 to 60, had suffered a cerebrovascularaccident between four months and one year previously. All hadnon-fluent type difficulties, from problems at a single word level toword-finding difficulties within phrases.AssessmentIn our earlier groups, some of the tasks were at times unstructured,and emphasis was often placed on social skills. For this project, weaimed to develop more structured activities in keeping with thecJients' specific linguistic difficulties. To identify these, a broadselection of PALPA assessments (Kay et aL 1996)(TabJe 1) wasadministered to each client before and after the group therapy pro-gramme by a therapist who had not previously worked with theclient, but wh o was involved in the therapy group.Whilst we felt it important to measure individual linguistic gains,we were also aware of the need to assess interactive aspects of communication. We videotaped conversations between client andspeech and language therapy assistant before and after group ther-apy. A functional communication profile (Table 2) adapted fromthe 'Adult Communication Analysis', published by the Centre forIndependent Living in Ohio (Florance, 1981) was used to gradeclients on a five point scale, where 1 indicates a very poor and 5 avery good score in four different areas.An analysis of verbal picture description ('Cookie Theft' picture,Goodglass and Kaplan, 1983) was also used, following research b yMackenzie et al (1997) into right hemisphere deficiL The system,based on original research by Yorkston and Beukelman (1980) andMyers (19 79), exa mines the interpretative and literal units in clienLS'descriptions. Figure 1 is an example of the analysis technique

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 1998 13


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AP H ASIA

TABLE 1: Pre-Treatment Programme Assessment scores and percentage of change after.PALPA no. R.G. P.M. R.K. E.C. J.I.initial %change initial i'.change initial i'.change initial i'.change initial %change

score after score after score after score after score after2:Same-Dlfferent 55172 = 69172 +3i'. 63172 +9% 72172 = 72172 -11.Discrimination -4:Minimal Pair 29/40 +4% 39/40 = 81140 +101. 39/40 +2i'. 39/40 +1%Discrimination - -47:Spoken word 24 /40 +10% 39/40 +2% 39/40 = 40/40 = 38/40 +51.Picture Matching48:Written Word 25/40 -5% 40/40 = 38/40 +3" 38/40 +3% 39/40 -3%Picture Matching -53:Spoken 18/40 +7% 29/40 +15i'. 24/40 +10% 26/40 +27% 13/40 +331.Picture naming - r-53:Repeating 36/40 -3% 39/40 +21. 28/40 +30% 36/40 = 31140 +1Oi'.Picture Names53:Wrltten 0/40 = 22/40 +7'" 0/40 = 1/40 +38% 0/40 =Picture Naming55:Sentence-Pic. 28/60 +1% 54/60 -51. 84/60 +61. 46/60 +6% 39/60 +20%Matching (aud.)

I-56:5entence-Pic. 27/60 -8% 45/60 +1Oi'. 24/60 +20% 29/60 +9% 43/60 +111.

......

unication ProfileIABLE 2 functional Com m _--..---,-'-1\ \

Therapy\ \

-,communicative Success:, message acroSsAbility to get one s

Intelligibility:h orcl correctlyAbility to sa y eac W

Appropriateness:te ancl contextuallyAccura esappropriate respons

Efficiency:

2r \1 2r \23 4

\ \3 4\ \3 4

5

\5\5

The group ra n weekly for two hour sessions over twelveweeks with two therapists. The clients did not receiveany additional individual peech and language therapy.On assessment, all cl ients had prob lems both at a central semantic level and at the Ie eI of the phonologica loutput lex icon. Tasks were designed to target theseareas and three examples are detailed in Figure 2.These th erapeutic activities were designed to workprimarily on input and only at the end stages of the

12 week block did we try any verbal output tasks.We were aware that. although there is a great deal ofinformation wri tten on the benefits of group trea tment, there is minimal discussion of therapy procedures. Thus many group tasks are employed fromindividual therapy and there is a risk that eachclient is treated sequentially within the group, withlittle interaction between group members and thetherapist. What occurs then is not good grouphich are neither th era py but in effic ient individual therapy within aResponses W strictecl in length group setting. The tasks we used were taken from

abnormally con r R ~ : ; , - - - = = = = = : : = ~ ________ ~ o : u ~ r ~ j n d i V i d u a l therapy tas ks~ o : r ~ e : x ~ c ~ e s : s : i ~ v : e l ~ y ~ l ~ e n ~ g : t _ h . : . y_____- - l and at times it wasE - very difficult toa ~ ~ f Y g / ~ of literal and interpret t" adapt them fora Ive UnIts group therapy.P' Holland (1975)Icture description' reports we must beRight. ' ~ aware of theThe Wee bO\J is ct"'nd' _ Literal strengths and weak" ':..J.. ..


17/32

o f new tasks challengi ng but by arran ging them in hierarchies o fdi fficu lty it allowed cl ients o f varying severi ty to part icipate in thesame task with in the gro up . This also facilitated in terpersonalcom mun ica tio n betwee n clien ts as the y a ttempted to aid a nd helpeach ot he r.Alth o ugh the rapy tasks we re des igned to wo rk specifica lly o n thec lients' areas o f d ifficul ty, we we re aware o f the need to en cou ragem ore communicati ve sk ills. The re was a time fo r gro up discussionand the cl ients were left a to ne a t tea breaks to enco ur age them toini tiate and m aintain a conversa tion.

PALPA outcomesAn improvemen t o f a t least 10 pe r cent was seen in two or mo re o fth e nine PALPA assess ments with every cl ient (Table 1). Fou r of th efive cl ien ts ma d e- consid erab le p rogress in the spoken p ictu re na m ing assess m en t ( ran ging from 10 per cen t to 33 per cent ), and threeshowed an im p rovemen t of 10 pe r cent or more in the wri tten se ntence-picture m atch ing.Individual clien ts a lso improved s ignifi can tly on a nu m be r o fassess m ent s, ego EC sco red 33 per cent mo re on written pi cturena ming, IT imp roved by 20 pe r cent on sentence to p icture m atching (audi to ry) and RK by 30 per cent on repea tin g p icture names .Th ese areas a ll showe d prog ress even tho ugh they we re no t specifi ca lly targeted during therapy.'v\le fe lt the mos t encouraging change was o n the spoken picturenam i ng task, especia lly as the m ajo rity o f the rapy ac tivi ties d id no two rk on ve rba l output. Th e on e client who di d no t im prove by 10pe r cent or mo re still im proved o n his pre-assessment score by 7per cen t; it was later d iscove red he was su ffering from lun g ca nce rwhi ch may have affected his overa ll per fo rm ance.Altl10ugh PA LPA assessmen ts have not been fo rmally s ta ndardised,all ite ms used d id have d escripti ve sta ti stics for testing o n co nt ro lsubjects. We are awa re th at im p rove m ent s made in many of theassess ments would have to be rep lica ted o n re-assessm ent to be statis ti call y viab le, b ut fee l th e results to be enco urag ing considerin gm any o f th e cl ients had ceased to make gain s in in div id ual th erapy. We we re also aware o f the di ffi culties encoun tered in us ing thesa m e therapi sts to tes t, re-test and trea t th ese client s.

Functional outcomesEve n th o ugh funct io nal co m m un ica tio n was not specificall y ta rgeted in th erapy, small gains we re ma de by a ll ( tab le 3) . All clien ts'sco res im proved for com m un icative success (ab ility to get th ei rme ssage ac ross ) an d th ree ou t o f fi ve improved o n effi ciency ( m aking res po nses o f an app rop riate length) . Wh il e a nalysing th e videotapes, it became app are nt that cl ient s' comm unicative co nfi dencehad a lso increased , but th is was no t forma lly m easured.Initi ally cl ients had grea t d i fficulty ini tia ting a nd m ai nt ai ning co nve rsatio n am o ng th e group with ou t therapist input. After the twelvewee k b loc k, cl ien ts were mo re re laxed and begin ni ng to m at amon gthem selves in the wa iting roo m a nd at tea break. They a lso helpedea m other mo re readil y w hen com municat ion bro ke do w n o r whenon e of the group membe rs had particula r d ifficulty with a task.

Picture descriDtionTh e results of th e Cookie Thet t pictu re a nalys is showed m easurabl eimprovement in all the clie nt s' int erpretative u ni ts - with scoresincreaS in g by between two and six points - an d in fo ur of th e fivewith th ei r lit era l units (Tab le 4). Inte res tin gly, in resea rch o n no nbrain-in jured ad u lt s (Macke nzie et a t, 1997), the inte rp reta tiveunits we re foun d to be a m o re stabl e measurem ent th a n the lite ral un its.Even tho ugh this was a new assessment to us, we fe lt it to be par ticularl y usefu l in uying to measure discourse fo rm a lly.

Encouraging resultsKe-a rns (1986) has ~ although mos t gro ups targe t on e o rmo re pa ra meters, th ey are a ll in tri ca tely re lated and im pr ovemen t

AP H ASIA

Figure 2 - Examples of therapy tasksa) PhonologyGraphemes were written onto small pieces ofacetate and used with an overhead projector(OHP). A CVC word was arranged on the OHPand clients had to look at this while listeningto the same or another one spoken by thetherapist. They had to decide if the twowords were the same or different.Th is t ask was then expanded by asking theclient s t o identify where the change hadoccurred within the word. At this stage theywere given a choice of three gra phemes andhad to decide what the original grapheme hadchanged to. Init ially the choice of threegraphemes dif fered in all parameters (voice.manner and place) and as the task pro-gressed this was reduced until there was adifference in only one parameter.b) Semantics(i) Odd one out task where four pictures wereput onto acetate. These were closely seman-tically related. Clients were asked to selectthe odd one out and to justify their choice.This initiated a great deal of group discussionand debate. Examples are cokeltea/lemonadelmilk and bus/planeltrain/car.r----------------------,

(ii) The aim of th e task was to strengthensemantic links using semantic circles. Theclients had to identify which pictures could belinked to th e item in the centre of the page.

n L-'1j-'"",1 ~ ~I \\ } aD, j ~ ' "'---. ~ Q C f < .- ' Fi1/1 I l. ;.("""--1'-r--, ,~ '. ~ - - ~ ',f'!" . -,- ..-'(5 ./ / 11cu-sE

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SPEEC II & LANG UAG ET HERAPY IN PRAcrlCE SPRJNG 199 15
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APHASIA

TABLE 3: Difference between Pre and Post Treatment Functional Communication Scores.R.G. P.M R.K . E.C .DIFFERENCE DIFFERENCE DIFFERENCE DIFFERENCE

Communicative +1 +0.5 +1.5 +1.5Success - -Intelligibility +1 = +0.6 =

.,.

J.T.DIFFERENCE+1

+0.5

Appropriateness

Efficiency

=+1.5

=

+0.5

==

=+0.5

-+1.5

=TABLE 4: Changes in 'Cookie Theft description scores after treatment programme.

R.G. P.M R.K. E.C. J.T.DIFFERENCE DIFFERENCE DIFFERENCE DIFFERENCE DIFFERENCELiteral Unite +:3 +14 +4 +2 -2

Interpretative Units +:3 +2 +6 +4 +4

in one may affect the other. This study aimed to work on specificlinguistic areas and although improvements were seen in these,there was also significant progress in social and communicationskills.We plan to continue developing a group approach as we are veryencouraged by these results and feel the gains are well worth theeffort involved.ReferencesFlorance, C. (1981) Methods of Commun icat ion Analysis used inFamily Interaction Therapy. In Brookshire, R.H. (ed.), ClinicalAphasi%gy Conferen ce Proceedings. Minneapolis, Minn. BRKGoodglass, H. and Kaplan, E. (1983 ) Boston Diagnostic AphaS iaExamination. Lea & Febiger.Holland, A.L (1975) The Effec tiveness of Treatment in Aphas ia.In Brookshire, R.H. (ed.), Clinical Aphasiology Conferen ceProceedings. Minneapolis, Minn. BRI


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REVIEWS

CHILD LANGUAGEWord finding test essentialThe Renfrew Language Scales -repackaged I revisedCatherme R nfrewWinslowAelJon Pcture Test [16 .50 +VATWord Fnding Vocobul ry Test [1 9.75 + VATBus S o y Tes I 3.50 + VATFa - this four th edltJ on. the Renfrew LanguageScales have been repac kaged and each test isnow stored in a clearly marked box. Each testhas a sco re she et photocoplable onto A'i sizepaperAction Pictu re TestThe stimulus pi ctuJ'es. admin istration and standa rdlSatron are t he same as the thi rd edrtton.W hile the manua l is more clea riy laid out,overall the con ent is ver y srmilarWord Fnding Vocabu lary TpslThe stimulus pictu r-es have been updated andrepresent a more contempo ra ry vocabular yThe draWings ar'e mu ch clearer The standardisat.on has been re-done on a larger sampleBus StoryTe tThere have been slight cnanges to the picturedeSign an d colour.The story is now presentedin a Rip-book ' style with the spine at the t op.although p rs nally I preferred the readinguook sty le of p -eVIOU S ditions with the sp ineat the side - It was easier to um the pages , itset t he scene for 'sharing' a story book andIso r inforced the not ion of left-to-right ori

entation.The manua l is r ore clearly I id out althoughthe content IS ver y similar to tha t of the thirdeditron The s t a n d a Ion has not cha nged.The photocopiable score sheet prov ides aus ful guide fo r' sconng " in formalion" .In general:" The new packaging ma de the tests easier tostore than previous editions. However. as apenp,-.tet lC herapist. I also found the new test sbulky to carr y., I found the pietur-e aterial more durablethan previous ed ttr ns.

The standa 'disation sanlples exclude children Ith significant language difficult ies (egchildre in language units for toe Ac ionPictu re Test, chil dren wllo are or are likely tobe statemented for the W ord Findrng Test)The mr:ao could th erefore be artificially high,so children w ilh r:111d d ifficu lties may appear tohave mOr-e sign ificant problems.The Renfrew Language Scales CO tinue to be aval abl e assessment too l fO ' pae diatric speechand language therapists and studen ts. If purchasing new test material I wo Id co nsider theour' th edition oftheWor FiodingTest essential.Howeve'" I would want to co SIder seliouslye Ileed 0 I' place the hil-d editions of theA Ion Picture Test and Bus Sto yTest.Jill Pormo Jse is () speech and anguage therapistWIth the Un,ted BnSO1 Heollhcwe NH 5 Trust.Sht is /Ilvolved m a project ilnplementJng speechnd language therapy in mainSlfeam schools anaalso wUlk.$ WIth chrldren WIt! aubs n.

LANGUAGE DISORDERInfinitely readableLanguage Disorders in Childrenand Adultsed. S urla Chial James Low & Janel\IIorsh /IWhUl fISBN I 861560 14 1 0 4.50In the wo rds of Jane Marshall. th iSbook is w ri tte,) at an "Interestingwatershe d in Brrtish sp eech and language t hera py" . a t ime in \ hich psych ol 1l1 guislics are being appl ied Inboth developmental and acqU iredpathology. Acmss the board we arelooking at language processes ratherthan descr ib ing symptoms .Thi s booklooks at the lheory of psycholinguistiCS and the practical application o ft heory to assessment, therapy andappraisal o f effi cacy.The malll content of the book isdivided into four sections: phonolog ical processing, leXical processing, sentence p -ocessing d pragmatiCSThetheor y of processing is pr"esented ineac h section and IS followed by com,prehensive case histor ies of both childand adult clien . Each case histor yincludes exte ns ive informat ion regarding assessme nt and therapy tasks, aimsof therapy and evaluation oh he effec

of therapy. In each section ashor t 'aft erv'Iord ' dr aws paral lelsbe ween ch ild and adult cl ients.In summary Ma!"ia BI ck sta tes theba rn er s betw ee n child and adultassessm ent have been shown to bemore histOrical than theore leal. Shepo ints to the extensive commongm und which becomes inueaslnglyappal'ent to the I'eader as she pm gresses th rough this book.The book res Its from a conferencewhere individual spee ch arlO anguagetherapist researchers p l'E'sented wo rkwit h common gmund. It is therefo (e.at times . difficu l to be ce r-tain thatchild nd adult assessment and herapy are tap p ing Identical an:;a5 Theseweaknesses are discussed openly asare surprises i) therapy outco meswhich we II experience wo rking withrea l peop le 1Il dynamiC situationsThis book comb ines the t heol'eticalIS ues su rrou nding language processing alongSIde practical applicationswth bo h hdd and adul I is a mustfor therapists workln With larguagedisordered childre and a uits. It isintinitely readable as whole or eachsectr on or case history can standalone .Teresa Ead BSc (hons) ;\tISc RCSLT isa Senior Speech & Langu


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REVIEWS

AUTISMMany ideas will be usedAutism - P.D.D. More Creative Ideas FromAge Eight to Early Adulthoodjanice I. AdamsAva ilable (rom WinslowOrderre{: 163-3635 97 06.95This is a very practical book ror pa rents. ca rer sand professlonills. I contains l i ~ t l e theory bou tautIsm and PO D and assumes readers are famil Iar w Ith the ImpaIrments present In these co d"tions. There IS some 0 erlap with the uthor'sprev ous book.Autism - PDD. Creaave Ideas dUringrhe School Years. Th,s bo ok how vel" contaInsmOl'e suggestions relatIng t o teenage years anadulthood an area less well rep esented In the hterat re on utism.The author IdentIfies he develop ent of a prop,iilte SOCial and communICation sk ills 1S a strandthat should run through pr grammes for everyalea of defiot. She suggests that we hdve to gaInInSights into the orid o f an utistic person to beable to help them. and modIfy the curncl/lumaccordingly.The book IS dIVIded int four secons - 'SoClabfil:yand Commun 'catton: 'Benavlou r, Feelings a- dEmotions '. Relationships. Sex rty and the FaMily'and 'Bridging the Gap' (inclusIon of the autiStIcperson in society) .Eilch sectJon begins WIth quo tatJons from pe pieWith autism including Donna WIlliams and Temp eGrandin and ends w ith anecdotal examples andcase studies,These al-e very pow rful and emojive. The suggesti on ru-e a co plla 1011 of ideasfrom profes lonals. families and caregivers and arever y practIcal. The sectio about sexuah ty orexample 0 Llines ways of he p'ng the parents andSiblings cop With the changes occumng inpuberty and gives practical suggesl10ns for copinwith senSItIve Issues such as masturbation nd-n ns rua lon,Throughout the b ok here 15 an emph sis on thedevelopment of fundi nal con municatlon. TheJse of ymbol 5 stems is seen as a way of givlllgthe autistic person access to communic ti on in aWider community There are many useful Ideasabout developin symbo use. br ex mple tosupport behaviour programmes and to helppup"s to become aware of heir own emotio s.There are very clear illustrall ns of symbol sys-tems and suggestlon- fOI ' making these flexiblend portable.

The au hor stresses hat many young people Withautism have lives contro led by others an d suggests ways in which they can be helped to makech o ices and decisions about their own hves. Shealso describes ways of developino self monnonng.th ,Stext descnbes an American system of educatio n and care in wh ich there is greate emphasison Ineiuslon than t he re is currently in this (Q untr y.The layout is inconSIstent: although so me checklists are ver y c l e a other sections are con fus ing. Itcan be dIfficult to fin d specific information asthere is no index. W hen an activ' y is outlined thelack of detail is som etimes frustrating: however,there clre many re fe rences t o boo ks and journals.I found many Ideas I will use w ith our pupils. W eWIll certainly include thiS book in our staff libraryand wou ld recom mend it to pa rents and carers.especially those w ith children who are approach ing adolescence.Sue Allison, Speech and longuage Therapist. ISDeputy Head at Ins ope House, Cheadle, Cheshire,a schoo l (or chIldren With autism.

PRAGMATICSSkilful weaving of theory andpracticeWorking with PragmaticslUCie A dersen-Wood & B nita RoeSmithWinslowIS8 0 86388 /68 8 2 7_50WorkIng With Pragmatics is no t atome . It IS however an excellent,we ll-researched and logically wnttenboo k. As practical. down t o earththerapist I like books at answersimp e q u e s l 1 o n ~ like w at? hy?'lOd. most Importanty. how l Thisbook does exactly that.The fi rst two chapters expi In andefine pragm ICS. There IS also anoutline of heorelical approaches topragmatics. ThIS means the I-eade!"can ge a qUIck. comprehensive con cept 01 the commonest theories.TI1eres of the book I devoted 10 pragmatIc developmen assessmen andtherapy Students will love this book- as a student. I well ,-emember askIng the perennIal question. HOW?The chapters on assessme nt e courage clinrcians 0 be thorough in bothIon al and informal analysis of pragma ic disability. Thel'e IS a usefulover vIew of formal assessmentsavadabl and some helpful 5U eslions, The pragmatic rating scalecould be used to priol'itlse cases Th,smeans one can be confident In planning th ne essary Intel' enlion.making h,- book acceSSible 0 1- chni Clans and students ahke . H Ing readabout theory and assess men weal-e dil-eaed to hlnk about pr ventlon of problems and trainmg ofother professionals. famtl y nd caregivers. Th,s book reminds us weshould be sharing stra egies withcaregl 'er5 and enabling them toeffect change in their pproacn tocli ents With pra matlc dlsabil y, ischool and at homeThrough ut thisbook he au hors skIlfully weave thetheory and pl-ac Ice t ogether; c arifyIng and formaiislng orking w ithprrtgmatlCs. As a therapist worklngprimar i:y In th e classroom, I am sureth,S book WIll incl-ease my abilIty tow OI-k With cileills, parents and otherprofess:onal co lleagues more effectIvelyWorkIng with Pragmatics ay bemo re appropriate for the paediatricclinl ian but I feel It wo uld In form hepractice of both teachers and st .dents. It co tams facts relevant fO- allprofeSSionals wo rkIng " i h Individuals w ho have dIfficulty Inte ractingwith o thers. Finally. fo r those whobec ome "hooked on pragmiltlcs".there IS an annotated bibliographyal lowing the reader t o select areas o fresea rch they migh like to Investigate furtherCarole E.. HIgginbottom IS a speecand language therapist at Stam]House School.

DYSLEXIAInteresting, but no surprisesDegree Students with Dyslexia -Growing up with a Specific LearningDifficultyBarbara Rldc.h Manon Farmer &01ristophf" SterlingWhu(rISBN 1-86156041 9 { /9 .50Part of a wldel ' research st dy. this bookhas been published to draw attention toth need to identify and suppor t st dentsw ith dyslexia who are in highel' education,The main bulk o f the book IS gIven over toin-depth interviews with nIne dyslexi stude'1ts wh ose ag s ranged from 18 - 42ye I-S. They came from a wide r"nge ofsocia-economic ba ckgrounds and w erestudymg for a var iety of degree s. The students volunteered to t ke part and mayot therefol-e be r'epresentat,ve sample.

Full data w as collected on I 6 dyslex ic and16 control students. On ly the dyslex ic students w I in l rviewed. the ,ntervlewsbeing carried ou t by a research assist nt.himself dyslexicThe A ult Dyslexic Checkhsl (Vlnegl-ad) wasused to olscnminate e x i c from nondyslexic students I had t o track thi dowon he Inteme t as only three of the twentyquestions wCl 'e quoted. The highest rankingquestion indicating dl'slex ;a was" he1wntlng cheques co you frequently findyoul'Self makIng mistakes?"The least Important was "When you have to say a longword do you 0 e ,mes fi d It dimeul toget ali the sounds In the right order?" Hmm!The nter'"iews make Intel-estlng readinowhile not producing any surpnses. 0 Iyone student had been diagnosed befc re histeens and several were no as essed untiltheir mid-twenties There IS grea vanationin the type and seventy of difficulties both

practical and emotional e r m ~ asdescribed by J1e students.. Almost all thestudents ,-velcomed h" ng a label 0 attachto heir problems.Sev ral of the students felt they hade celled at talking an d preferred oral pre sentation while others lacked confidenceand found It hard 0 order their thoughtand xpress t hemselves. I searched thebook for any referenc e to speech an d language disorders nd found one paragraphnear the end o f the book: S ckhouse &We lls (1991) were quoted - dysle XIa hasbeen called "a hidden speech and lilnguagedisorder" and Snowling I-eports that dyslexIC children often have a history of Idte ortroublesome speech and language developme t. ot one of the dents was askedabout any early d,fficulties in th e interViews,If thIS book goes some w y to imp roVingsuppor t services for such students th t (anonly be a goo d thing. The author feltdyslexIC children. their famIl ies and pnmaryan d secondary teach ers would find th isbook use ful. H ving read the interviews. Iwould have I ciuded university lecturers ontha t list. I wou d recommend this book t othe above and for rncl us ion in co llegelibrar ies.Sheila Gunn Is speech and language therapIs tat Derwen College. Osw try. Shrop shire.

18 SPEEC H & I.ANCLJAGFTH ERJ\PY IN PRACIICE SPR ING 1998


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REVIE'NS

CONVERSATION ANALYSISInterpretation needs skillCAPPA I CAPPC/Ann Whitworth. Lise Perkm s, Ruth LesserWhurr55 00 eachIn rec en t years, Iesearch concem lng Conversati onAnalyss (C A) and its clinical application has beClaccruing at a rap id ly Increasmg I-ate. The CAP PA(Conversation A nalysis Pro fil e For Peo pl e WithAphas ia) and CAPPCI (Conversa Ion AnalysIs Pro frl eFo r People W ith Cog'1ltlve Impa irments) have be endeveloped as resources for speech and languag e t he rapists to help Inco rpor-ate pnncipl es of CA into assessment fo r peop le with generalised cogn itive Im pairmen t - as in demen t"l or fol lowing head inlury - andpeop le wi th aphaSia. Tl,ese dSsessmenls JI-e t o beused in close collaborati on with the cl ient's conversa tional partners and as an adjunct t o linguisti c measuresof language disabili ty.Bo th assessmen ts ale well presented and clearly IclJdout In a formal th;:!.t is eaSily accessible .They are pre ,sented us ing a slm .lar deSign and compnse:., a structured mtel-Vew to be conducted with the keyconve rsa tional partrer (and also for the person wrthilphasia in the C AP PA), an an alyss procedure fo r use with a ,en minute sam-ple o f conversation between the client and his I herconve rsa tional partner'" a summary profile that contains InfOI-matlon gathered from the Ilterview an d conversat ion sam p leallOWing companson of th e two so urces of informati on and establ ishing a ba se line fo r analysis.Bo th the CA PPA an d CA PPCI take a long t ime toadminister and scoring requil -es much intel-pretation,agalO ext remel y tim e consuming .The structured interviews p r-ovlde a useful fo rmat foreliciting In for mation on the clrent's cur l'e nt conve rsati onal ilbil ities, interaction style and any ch anges thathave occun-ed . The questions included in the interviews cover il w ide range of areas and allow for discuss ion on any cUI Tenl strat egies in use, the cli en t'sresponse to such st rategies an d the seventy of th ebehaViourI fee l su ch a detailed in tel"view for-ma t IS not approprrJte for use w ith some clients and carers. In par-t lCular ;I found th e interview w iLh the perso n wi th ap hasia Inthe CA PPA only surtable f,) r a restr icted num ber o fclients With relatively well preserved fu nctional language com prehenSion Jnd expl"ession.PrOVded a suitable conversation sam ple can beobtained, thiS analYSIS can p"'ovide usefU informatIonto help cliniCIans deVise highly Individualised therapypm grammes, and carer training programm es. Theanalysis procedure rollows a detailed and at times

I n t ~ e t a t system. which demands an In"depth knowledge of 1he assessments. Tllis pro ce dul'eIS again extremely tim e consuming.Bo th the C A PPA an d the CAPPCI successfully aSSimi la te and consolidate th e many stl-ands or In formationand pnn Cl ples of CA into Lwo useful assessments.Ill fo l"ll latlon gamed fr'Om uSing these assessments ISundoubtedly extremely va luable, alth ough Inter-pretatloii r-e l:es hea Vi ly on the sk ill o f the cl ini Cian : there 15 adea l'th o f gUidelines prOVded vvithi n the assessmenton ap propriate th erapy goals.The deta il inclu ded with in thes e assessment s is fu ndamental 10 the prr nciples of CA. however, given [hegr-e


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each,also in . d DO"a ~ a i \ a b \ e in a The "Say anavailable

'best worksheets . t k.coO\binatiOll to reoders are. p, 'z,ch, l.

and sticker charts.

READER O FF ER

couJJesyWinslow

Books tomavaliety ofpublishers andco en g he 'ange of speech andlanguage erapywork are rs: d 'd e Evaluation ofBe Sl DysphagIaB.E.D.

Introducing Strategies forParents andProfessionalsJanice I. AdamsThis author 110s alsowritten Autism-P.D.D.Creative Ideas DUring

Th e Mighty MAnita Robbins & Gam ejackson arahfiFor two to six Players Orderrom three to seven referenceyears, this board ' ' 4-3443_98game is a {u 29.99 +

Work on o r a l " r n : ~ : / o VATSkills. The instructor'SIncludes game ideas manualreprod 'bl ' aUC/ e parent tdescriPtions ,etter,the motor e x ~ n d PIctures o{ al/

Ph rC/ses alld aIw ysaaia ble fo r re ie ; hereviewe rgets to keep theDok. As aspecial 0 er, ona

Order Edward Ha rdyreference The BED.ThI alm s1sn89,91 to be a com pre-

the School Years andMore Creative Ideas FromAge Eight to Early Adu lthood. Bath

otocOpiable paperbaPUPPet pattern H d 'gare also p r o v i d ~ d ; n mirrorsthe exercises. or teaching) 6 .9S + hensive bu t easyVAT bedside dysPhag iai rst come, first servedoasis,

reade rs offeringto do areview\ il also be given he choice ofone of the products below.Phone Ari Ncoll on0I5697403 48 or witetoher a:Spee ch &Lnguage TherapyInPactice, FRE EPOSTSC02255,STONEHAVENAB39 3Z L,or e-ma il [email protected] findou what books ' reavi lable O'revew and to ake advantageofthisoferGude ines for writinga reviewII> ill be pro ded,The products belownew to the 198Winslowcata ogue,are be ing madeavalablefree by thecompany o readerso Speechand a guageTherapy inPractice. Wnslow doe s not publishthese prod cts b distnbutes themIn heUKIn 198, inslow ispublishing JUst onema in ca aogue Ith fou rteen extrapages,anew look and fo ur keyareas -Educatio ,Heal h,Ederly and Soc'alCal'e. Fora ree copycon tact LnSmth on 018 69 244644or write toWinslow Press Lim ited, Free post 327,BCETE Oxon OX6 OBR, UK.

e a . ~

20 SPEECH & U\:--JC LJACE T H ERAPY IN PRAcn

use Int I'or adults. tassessme I' Iincludes a screen, : e o;rolmotor evaluation, .Pharyngeal Dysphagia hs Assessment were~ ; ~ ~ : n d liquid is intrOduced

Pee,. 'nte,. ,Order an d S actIonself.reference Esteem068-3604,98 AnnM39.95 ' arquis &EIameAddThiS m Y-TrOut...J anualueve/oPed " WasProtessianal fc helpcOm :s aCihtatmUnJcation e SOCIalInteraction and PeerWith among ad, Ilearnlnu ...J o l e s ~co ..


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COVER STORY

I

......earnln rou

number of recent changesand developments in higher education, clinical education and adult learningtheories prompted tutorson the BSc SpeechPathology and Therapycoul-se at the Unive(sity of Manchester toconsider ways of developing the clinicaleducation offered to their students, The

most infiuential of these factors are: Developments In university teaching andadult learning in general, high lighting thevalue ofa) experiential learning, as opposed to

Julie Marshall andCatherine Aldredobserve that a

supplementarylearn ing packageusing video canbe a valuableway ofsupportingclinicaleducationin spite of the

initial time andcosts involved,

didactic classroom based teachingb) Problem Based Learning, aimed atdeveloping analytic and broad based problem-solving skil lsc) self directed learning, in which studen tstake greater responsibility for their ownlearning needs and processes, Increased availability 0 teaching temnology, such as video, computer-s and multimedia, Pressures on university teaching tim eand drnlca! placements, These pressl1resInclude inadequate time for Ol1e-to-oneclinical educ tion within the un iversity setti g, i sufficient eli ical placements, partle-

SrEEGI & LANGUAGETHERAry IN rRAcnCE SPRING 19 !J 21


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COVER STORY

Figure I: Example of written tutorialquestions and sample answers:

Voice assessment videoI, What are the main factorscausing vocal abuse (for thisclient)?Shouting at child ren,occasio nal throat cleal'ingand high volume,

2. Why does the therapistphysically examine her neckand shoulders?To look for ' signs of tens ion,asymmetry and to assessdiscomfort and tenderness,J How will the therapist'sexplanations help the patient?Decrease anxiety aboutcause of problem, 91vepatient positive things thatshe can do to impro eher voice, understandi ng ofhow natura l actionsand her own anx iety havecaused her symptoms.

4, Are there any additions youwould make to the end of thesession?Ask patient if she hasquest ions, has sheunde rstood , how does shefeel about what thetherapist has said, has shethought of any otherfacto rs while the assessmenthas gone on?

ularly with certa in cl ient groups, an inability to provide every student with opportu nities to wo rk with every cl ient group andspeech and language therapy managers'concerns about the limitation s on clin icalexperience for students' cl inical development and future employability An increasing awareness that there are anumber of core clin ical competen ciesapplying across as well as Wi thin clinicalfields , and that students ' increased awareness of the transferability of these skillsmay improve their clinical confidence andeffectiveness.ProjectdeslnA number of projects to sup port cl inica leducation and learning were consideredand implemented in light of these factors.One suc h project cons isted of creating aset of videos t o support the cl inical edu cation of final year students. It was anticipated it woulda) be relat ively easy to implementb) provide a permanent resource andc) be virtually free of both material costsand time commitments in the long-term,although time consuming an d expensivefor both NHS clin icians and university staffin the short-term.Enterprise in Higher Education (EHE ) wasa partly government fun ded initiative toencourage inn ova tive developments toImprove the employability of uni versitygraduates. This project appeared to meetEHE funding criteria and a proposal submitted in A pri l 1994 was subsequent lyawarded.W e planned to produce ten videos, eachof 20-40 minutes with the focus on aclient with a specific type of communicat ion d i s o r d e ~ The disorders selectedreftected areas in which it had recentlybeen difficult to obtain su fficient clinicalexperience for all stu dents.These includedcl ients w ith voice disorders, acquireddysarthria, acqu ired expressive and recep tive dysphasia, Per vasive Commu nicationD isorder, hearing impairment and users ofAugmentative or A lternativeCommunication. The number of Ideaswas restricted to elghl by the fundingavailable. W ritten tutorials would accompany each vide o.ImplementationFollowing the successflll bid. an expenenced the l'apist was appointed to co-ordi nat e the project for 40 days betweenOctober 1994 and June 1995. Speechand lan guag e therapy managers weresked for suggestions of ap propriate staff,cl ients and locati ons. Individua l therapistswere then contacted and, if su it able clientswere available and agreed to be involved .filming took place within their usual clinicalset ting .The videos we re made and editedby the project co-ordinator and a videotechnician . Speech and language therapists

gave their time and energy w ill ingly,despite heavy workloads and were gene rally very sup portive of the project.FollOWin g filming. the videos were editedto fo cus on spec ific aspects of the clinicalsessions . Written tu torial quest ions weread ded to the vid eos and samp le answersprovided by teaching staff Fgu re I provides an examp e from the voice assess-ment video. Questions related to spec ificaspects of the clinical session and weremodelled on typic I observation, practicaland theoret ical tasks given to studentsduring live cliniC observation session s.Seven videos were ready for use byOctober 1995 and the fin al one was rea dyby October 1996.Students are expected to watch all eightvide os at ti me s of their choice dUring thefina l acade miCyear, but only have to complete the tutorials on a minimum of fourof the videos, selecting those relating toth e cl ient groups with which they haveleast clinical experience. Completed tutonals are not assessed. but the studentsevaluate their own performance aga instthe sample answers. if necessary w atchingthe video aga in. View ing facilities are avail-able with in the department and they arenot permitted to take videos home, topreserve client confidentialityEvaluationThe video lea rn ing package has so farbeen used by two groups of ~ n a l yearspeech and langu age therapy students.Thei feedback. both verbal and w ritten,has been 0 erwhelmingly positive.The most reqt;ently watched videos weredysarthrta and dysphonia. both used byI 8 per cent of -r e students. followed byMC and ~ s e aphasia . studied byI4 per cent arc -:: per cent respectivelyThe least -rec;uefi - otched VIdeo wason hear 0 :Jill e 11. Eva luation wascarned : :;clore the end of the academic vear, :o rr ore may have watched themat c laier oate.S ..cents' ere asked to rate the videos ona scale of one to five for their usefulnessfIVe bei ng "most usefu l" and one be ing"least usefu l"). Twenty nine per cent of the

videos were ra ted as five, 64 per cent asfour and seven pe r cenl as one. Examplesof the comments made by the stu den tsinclu ded: The tu tonals focused my thoughts andview ng He lped impmve my observation skills Insp ired discussion between fr iends Ifwatched in a group Some of the treatment procedureshelped me both to supplement and rejectsome of my own approaches Gives a credible source of therapy Ideas.Most students wanted more videos on awider rang e of client groups. Negativecomments were !I1d.i nly rel ated to theneed to improve the written tutOl' ia ls andthe viewing arrangements.Clinicians have not been asked formally to

22 SPEECH & LANGUA GE THERAPY IN PRA CT ICE SPR ING 1998


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evaluate the project, but al l those who are aware of it. erther through direct involvement or th rough their students, have commented favourab ly on rt. Univers ity sta ff involved have found it useful to have video m terial us ing therapists other than th emselv s and to have a practi al supplement to lectures. It has been avery positive development to work closely with colleagues in the NHS and has fos-tered the view that clinical education is aJOint endeavour shared be tween thosewho are predominantly cliniCians andthose who work predom lnan Iy in educational institutions. A lthough the projectwas t ime-consu ming and expensive todevelop, now that it is complete the timeinvestment is minimal. Staff have devel-oped skills in implementing suc h a projectand have been encouraged to use morefrequ ent videolng of their own clinicalwork, thus making it available t o largergroups of students.

C ~ a n g i n gPriOritiesThe client groups shown in the videoswere selected for two reason s: thosew he re it has been difficult to obtain sufficient experience for all students, andthose with particularly complex difficulties.It was interesting that for one of t he or ig-inal groups chosen - cl ients w rth cquil"edrecept l e aph asia - no video was made asno surtable clients were ava ilable. The reasons given by therapists were that they areno longer being referred such dients butare much more likely to be see ing clientswith global aphasia or those with dysphagia. It IS not clear whether this IS a common situation but it ma y refiect increasedcont racts for acute hospital based asopposed to community services.This issue

Questions

I'aises questions about the client groups ofwhich students are expected to ga inexperience, and the need to monitor thech anging treat ment priorities in the NHSand ada pt ed cational courses accordingly.FutureDevelopmentsThe success of the project and feedbackfrom students has generated ide as for further developments Includ ingI. Development of videos involving awider range of client ro ups. These cou ldbe used both to supplemen t current cl inical experience an d to preced e it.2. Use of some of the materials by groupsof stu dents, such as those studying communication, lingu ist iCS and communicat iondisorders and also by applicants to speechand language therapy courses (only withpermission of clients and therapists, astheir or iginal permission did not extend tothis usage) .3. Development of a larger bank of videomaterials, some of which could be ed itedfrom the original videos, to demonstrate awide range of core clinical skills.Unfortunately these plans cannot goahead unt il further funding is available .UsefulSupplementThis project has provided the universitywith a mean s of supplementing students'clinical experience without puttingincreased pressure on already overburdened cl inicians and educators. The use ofstructured video teaching materia ls canneve r replace hands-on clinical experiencebut appears to be a useful supp lement.pa l"tlcularly at times when students wouldnormally be carrying out substant ialamounts of observation.

Answers

COVER STORY

Julie Marshall is a Lecturerin Speech Pathology at theCentre for Audiology,Education of the Deaf andSpeech Pathology,The University ofManchester;Oxford Road,ManchesterM 13 9PL. Fax: +44 (0) 161 275 3373 Phone:+44 (0)16/2753376/3389Email:Julie,[email protected] Aldred is aLecturer in SpeechPathology at The UniversityofManchester and aSpecialist Speech andLanguage Therapist withStockport Healthcare Trust.

Why are new waY5rMMI Development5 in adult learning theory, of learning beinqW M . ~ J technology, core competencie5 and pre55ure5e x p l o r e d ~ on teaching time and placement5 need tobe accommodated.What do 5tudent5 IIIfII!nI di5cu55ion and therapy idea5. 1iMt.. The video5 can facilitate ob5ervation 5ki1l5,like a bout the videopackage?

Have there been The U5e of video ha5 been extended a5 a benefit5 for 5taff?N ~ . N ~ I practical tool and the joint nature of clinicaleducation empha5i5ed through the workwith NHS clinlcian5.

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 1998 23
mailto:Julie,[email protected]:Julie,[email protected]


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Howl

language therapy team leaders for Fosse HealthTrust in Leicestershire. Both specialise In workfng

with adults with learning dlsabfittles.The adult neuro team with South Downs Health NHS

Trust is Helen Garratt, Val Fam , Sharon Qarlc, MaryrCJS(tMcKay, Joe Osmond and Usa Cox.Ann Adams is the Oinic (o-ordinator of a team of

speech and language therapists based at East SurreyHospital, Redhlll.

(aseload .management IS askill u i r e d of anysoeech and language therapist, whateverthe numbers or dientgrQup involved.Balancing availableresourceswith .developments In theprofesSion and thewishes ofclientsbringsmanPressures. reeconbibutionsdemonstrate thereaJi!y ofgoodcaseloadmanagement :-n o t s o m ~solution tobe found but anongoing, e\(oMngteam exerase.

24 SPEI'C I1 & lAN C:UAGU 11-l [ RAJlY I IRAC'f1C E SPRING 1998


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HOWl. ..

,AduH Leamin Disabi Fromq toqu

South Down Hea lthU l llUII Iyand demand

Teresa catdlesideandJ fdcIestoneexplain hcMttheir tmm is worldngtoMm1sptrJVicb;Jamorejlexliesmtb?The invitation to write this arrived at aninteresting time. Like other departments,we have found ourselves subject to manychanges over the past few years. We havebeen reviewing ou r service as a whole,looking at ou r ways of working an d identifying ho w we could improve and makelimited resources more effedive. Caseloadmanagement is a major consideration .The teamWe form part of the speech and languagetherapy learning disabilities team comprising a full-time manager, three team lead-ers, a specialist in profound and multiplehandicap (PMLD), a specialist and a chiefpost in working with individuals who challenge services, seven generalist therapistswhose caseloads include adults with learning disabilities (based in Day Centres) andthree whole time equivalent assistants.We are divided into three teams, North ,South and City, based on geographical andsocial services / hea.lth care divisions covering a population of 2785 individuals withidentifled learning disabilities(Leicestershire Register of individuals withLearning Disabilities). Although not allknown to ou r service, mo st will be seen forassessment an d / or thera py at some time.Problems facing us include:1. Numbers Although a comparativelylarge departm en t. the sheer numberalready on our caseloads makes it very difficult to manage the caseload successfullyand maintain a consistently high standardof therapy. [n some ways we are victims ofou r ow n success as development work withother professi

Documents

Speech & Language Therapy in Practice, Spring 1998