Documente Academic
Documente Profesional
Documente Cultură
Groups
Adapting the
environment
Sensory
integration
Getting in synch
Home
programmes
Reducing risk
In My Experience
Valuing voice
ISSN 1368-2105
R E F L E C T I V E L E A R N I N G
http://www.speechmag.com
Student training
a unique
partnership
How I manage
early feeding difficulties
My Top Resources
In the community
Two great
reader offers
Photo from: www.johnbirdsall.co.uk
http://www.speechmag.com
In 1999, Professor Sally Byng spoke to
speech and language therapists from all
over Scotland about her vision of aphasia
services. A year on she was back with
Carole Pound to hear first-hand the
changes that have been made. Annette
Cameron reports.
SIGNALONG researcher Kay Meinertzhagen
recently spoke to a group of learning
disabled adults as part of a project to
establish signing vocabulary for self-
advocacy. What they told her has
implications for the project and for service
providers generally.
The Autumn2000 speechmag web-
site includes:
www.speechmag.com
Also on the site - contents of back issues and news about the next one, links to other sites of
practical value and information about writing for the magazine. Pay us a visit soon.
Now available: subscribe or renew online!
Reprinted articles
Student teachers recognise their voice needs (Roz
Comins, 2 (4), August 1993)**
At last...stammerers get the right prescription from
their GPs (Lena Rustin and Elaine Kelman, 4 (1),
Nov/Dec 1994)**
A service resource - New ventures in group
placements for students. Part 2 - Group placements
with adults with a learning disability (Ann Parker
and Rachel Farazmand, Winter 1997)***
From Speech Therapy in Practice* / Human Communication**,
courtesy of Hexagon Publishing, or from Speech & Language
Therapy in Practice***
tel: 01561 377415 www.speechmag.com
reflective. creative. hardworking.
original. energetic. friendly.
approachable. thoughtful.
interesting. realistic. up-to-date.
reliable. the magazine thats you.
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 1
20 Home programmes
...when parents understand more fully the nature of
their childs stammering and their role in its
remediation, they are often very resourceful in
making arrangements so they can attend therapy.
However, for a minority, there may be reasons...which
mean regular attendance is impossible.
Sharon Millard, Frances Cook and Jane Fry
explain how a new approach is benefiting children at
risk of persistent stammering who are unable to
attend a clinic for therapy.
24 Further Reading
Early intervention, hearing impairment,
dysarthria, AAC, dementia.
25 How I manage
early feeding
difficulties
Feeding management should always be
seen as multidisciplinary. This is sometimes
difficult to put into practice in community
caseloads but, the more we consult our
colleagues such as dietitians and
psychologists for advice, the more we gain
professionally - as do they.
There are many questions about the speech
and language therapists role with early
feeding difficulties. Sue Strudwick,
Joanne Marks and Sara Russell provide some of
the answers.
30 My Top Resources
Recent groups have been either language disability-
focused or project-based;
for example people with
aphasia produced a leaflet
for others with aphasia.
For the near future we are
hoping the service will be
able to replicate a model
of effective group
intervention via
conversational analysis.
Linda Armstrong and
Alison Parsons have to
adapt their working practice
to take account of the
geographical spread of their
clients - adults with acquired
neurological problems.
SUMMER 2000
(publication date 28th August)
ISSN 1368-2105
Published by:
Avril Nicoll
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AB30 1UL
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e-mail:
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Avril Nicoll 2000
Contents of Speech & Language
Therapy in Practice reflect the views
of the individual authors and not
necessarily the views of the publish-
er. Publication of advertisements is
not an endorsement of the adver-
tiser or product or service offered.
Any contributions may also appear
on the magazines Internet site.
2 News / Comment
4 Groups
As therapists, we were reminded how little we
normally adapt our usual working practice, as we are
often unaware that our clients have particular
sensory impairments... We found small changes made
a big difference when enabling clients to achieve
success.
Christine Griffiths and Alison Gedling investigate
the efficacy of speech and language therapy for
people with learning disability and sensory
impairment attending a Day
Centre.
8 Sensory
integration
Speech and language therapy
assessment and intervention
techniques with, for example,
children with speech disorders,
have the potential to be
informed and transformed by
sensory integrative theory and
practice.
Olwen Pate reveals how
getting suck, swallow, breathe
in synch can facilitate progress
in oral motor skills and speech.
11 Reader Offers
Win CELF and Speech Sounds on Cue
12 Reviews
Adult neurology, syndromes,
dysfluency, progressive
neurological, language
development, education,
articulation, autistic spectrum,
child development.
18 In my
experience
The cry of a teacher in vocal
distress should not fall upon deaf
ears; rather we should seek to
ensure it is never raised at all.
Caroline Cornish on the case for
a national policy of preventative
voice care for student teachers.
Contents
AUTUMN 2000
Cover picture:
See page 14, Competence, confidence
and commitment.
Photo from: www.johnbirdsall.co.uk
www.speechmag.com
IN FUTURE ISSUES
FRAGILE X PROGRESSIVE NEUROLOGICAL DISORDERS DOWN SYNDROME
PHONOLOGICAL AWARENESS DYSPHAGIA TRAINING
Training
We have been moving towards
emphasising reflective cycles of learning
which integrate practice, theory and
rehearsal, rather than the traditional
linear model with its expectation that
theory and observation should always
precede practice.
Suzanne Beeke and Ann Parker are
behind an innovative programme
where speech and language therapy
students become temporary volunteers
for the Stroke Association.
14 COVER STORY
Please note our new address!
Inclusion and autism
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 2
news
People with aphasia
are being encouraged
to demand an ade-
quate service.
Members of the
charity Speakability
have developed a
Charter for People
with Aphasia
based on their
own experiences
and reflecting
clinical guide-
lines endorsed
by the
Depar t ment
of Health. It
includes a list
of speech
and lan-
guage ther-
apy rights.
A recent
survey by
Speakability draws attention
to the paucity of aphasia services and the drain
dysphagia care places on resources.
Helpline Freephone 080 8808 9572 Mon-Fri 10am-4pm
Speakability, tel. 020 7261 9572.
A new report slams the quantity, organisation and targeting of care and treatment
for people with disabilities.
As a result of the reports findings, the Royal College of Physicians has produced a
set of recommendations for commissioners of healthcare, NHS managers, medical
educators and doctors aimed at redressing the balance towards the needs of dis-
abled people. Specifically, they want to see the specialty of rehabilitation medicine
developed, adequate staffing levels and a change in medical attitudes so doctors pro-
mote disabled peoples abilities and empower them to participate in society.
However, a British Society of Rehabilitation Medicine survey of NHS resources sug-
gests there is a long way to go to meet the recommendations. The tenfold or greater
differences in access of disabled people to NHS consultants in rehabilitation they
identify lends support to the theory of rationing by postcode, and they call for
inequities to be addressed urgently.
Medical rehabilitation for people with physical and complex disabilities, RCP,
www.rcplondon.ac.uk
BSRM, tel. 01992 638865.
The charity Scope has welcomed an Audit Commission report highlighting waste and
failure within NHS disability services, and urged an immediate crackdown.
However, Scope says the government should have introduced national standards
years ago and is disappointed that the report still fails to emphasise the need for NHS
providers to listen to disabled people. Its campaigns officer says, If the providers of
such services had a duty to take on board the views of equipment users, there would
be far less waste and inefficiency. For disabled people to achieve equality and inte-
grate into mainstream society, the government has to ensure that the right equip-
ment gets to the right people right now.
Fully Equipped (28/3/00) from the Audit Commission.
Scope, tel. 020 7619 7100, www.scope.org.uk
Children with autism and Asperger
Syndrome are on average twenty
times more likely to be excluded
from school than their peers.
According to a report commissioned
by the National Autistic Society, the
situation is even worse for more able
children with autism, of whom 29 per
cent have been excluded from school
at one time or another. The Society is
calling for urgent action to address
the lack of expertise, time and spe-
cialist help thought to lie at the root
of the problem. Its education adviser
points out that Parents of children
in autism-specific units and schools -
where exclusions rarely arise - are
twice as likely to be satisfied with
provision than those whose children
attend mainstream or special educa-
tion needs schools.
The report also finds there is less
awareness by the time a child reach-
es secondary age and that exclusion
continues into adulthood. Although
many adults cited a job as one of the
most important issues for their
future fulfilment, only two per cent
of adults with autism, including
graduates, are in full-time paid work.
Inclusion and Autism: Is it Working?
From the National Autistic Society,
393 City Road, London EC1V 1NG,
www.oneworld.org/autism_uk
Disability services
slammed
Dementia vision
People around the country are being asked for their views and experiences
of services and their vision of dementia care.
Alzheimer Scotland - Action on Dementia is working on a major project to
create a Scottish Dementia Care Services Template. At its core will be targets
for the range and volume of services which should be available to people
with dementia and their carers from the start of the illness to the final stages.
Essential services listed include memory clinics and rehabilitation / therapies.
Contact: Public Policy Department, Alzheimer Scotland - Action on
Dementia, 22 Drumsheugh Gardens, Edinburgh EH3 7RN.
Dementia Helpine (Scotland), freephone 0808 808 3000.
Partnership between carers, people with dementia and the research community
is also the aim of the Alzheimers Society which is recruiting people
for an advisory network to inform its research programme,
Quality Research in Dementia. Focusing on cause, cure and
care projects, 1 million per year has been com-
mitted, the largest investment by any
charity into dementia-related research.
Alzheimers Helpline: 0834 300 0336.
S.M.A.R.T. moves
An assessment to prevent misdiagnosis of vegetative state in patients with pro-
found brain injury will be available to rehabilitation units by the end of the year.
The Sensory Modality Assessment and Rehabilitation Technique (S.M.A.R.T.)
has been developed over a ten year period by occupational therapy staff at
the Royal Hospital for Neuro-disability. The hospitals brain injury unit treats
the largest concentration of patients in a vegetative state in the UK. Using
S.M.A.R.T., one study of patients admitted with a referring diagnosis of veg-
etative state found 43 per cent had been wrongly diagnosed. Such misdiag-
nosis can lead to a patient with the potential ability to communicate their
needs - such as someone with locked-in syndrome - spending the rest of their
life trapped in a damaged body. Vegetative state is the most profound form
of brain damage where the person is awake but completely unaware of
what is happening around them or within their own body.
The assessment provides a structured sensory programme which assesses the
five senses, movement, communication and wakefulness. The multidiscipli-
nary team and the patients relatives and friends are a key part of this
process.
www.neuro-disability.org.uk
Aphasia
charter
National screening
A programme to screen for deafness in new-born
babies is to be phased in from September this year
before being rolled out nationally.
The Royal National Institute for Deaf People has wel-
comed this development, saying The test can be
carried out within 48 hours of birth and does not dis-
turb the baby. It involves an instrument sending a
sound into the babys ear and measuring the level of
returned sound which calculates the level of hearing
function. The test is proven to be cost effective and
reliable. The organisation believes a comprehen-
sive national screening programme will enable earli-
er provision of aids, introduction to sign language
and development of communication. Health visitor
distraction tests used currently have a poor record in
identifying children who are born deaf.
RNID, tel. 020 7296 8000, www.rnid.org.uk
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 3
news & comment
Jane Austen knew
In a scene in Pride and Prejudice, Elizabeth Bennet observes that Mr Darcy
must comprehend a great deal in his idea of accomplished if he knows only
six such women. He and Caroline Bingley list the numerous qualities and skills
they consider necessary and Lizzy is forced to conclude I am no longer
surprised at your knowing only six accomplished women. I rather wonder
now at your knowing any.
What makes an accomplished speech and language therapist? A number of
clues come from Sue Strudwick. A therapist must be knowledgeable,
competent, empathetic, enthusiastic, honest and realistic, as this builds a
client or carers trust and confidence and contains their anxieties. How I
manage early feeding difficulties demonstrates this is enhanced when our
goals are patient-led, when we work with other professionals as a team and
when the organisation of our posts allows us to cross boundaries to provide
the consistency clients need.
Like teachers, our voice is the tool of our trade, but do we appreciate the
potential we all have to improve it? Caroline Cornish believes we should be
committed to development of the voice to make it the source of real
inspiration to others.
Initiative and flexibility are needed to carry out speech and language therapy
in challenging environments. For Linda Armstrong and Alison Parsons this
means some rather unusual top resources, as they work in a large rural area
where their adult clients are spread out and not easy to reach.
We need to remember to apply what we know. Christine Griffiths and Alison
Gedling refer back to their own guidelines as a reminder of small
environmental changes that can make all the difference to a client with
learning disability and sensory impairment.
We have to be responsive. Sharon Millard, Frances Cook and Jane Fry
understand that attendance at a clinic is not always possible and use other
methods - such as telephone contact - to ensure timely therapy can still be
provided to those who are motivated.
However, as Olwen Pate has found, the key to success is in the integration of
skills, and the challenge for us is how to facilitate this not only in our clients
but in ourselves. Suzanne Beeke and Ann Parker give us an example with
their innovative programme of student training based on reflective cycles of
learning which integrate practice, theory and rehearsal through active
participation.
As Jane Austen knew, we can pick out individual qualities and skills that are
important - but that wont tell you what distinguishes the Elizabeth Bennet
from the Caroline Bingley.
...comment...
Avril Nicoll,
Editor
33 Kinnear Square
Laurencekirk
AB30 1UL
tel/ansa/fax 01561
377415
e-mail
avrilnicoll@speechmag.com
Online consultation
A website is providing a groundbreaking method of
responding to a public consultation exercise.
Visitors to the Disability Rights Commission site can
respond online to a joint consultation with the
Department for Education and Employment on a
new draft Code of Practice for making goods and ser-
vices more accessible to disabled people. The draft
Code is posted on the website, along with a response
document which can be filled in and returned online.
The site meets high standards for accessibility and has
approval from the Royal National Institute for the Blind.
DRC, tel. 020 7211 3000, www.drc-gb.org
Education training
The national educational charity for children with
speech and language difficulties has extended and
developed the training it offers.
In addition to extra courses focusing on integrating
speech and language targets and approaches into the
classroom and curriculum, a series of seminars present-
ed by internationally regarded experts will provide an
up-to-date review of a range of topics. If distance is a
problem, workplace training encourages authorities to
purchase I CANs multidisciplinary training at a local
venue - significantly reducing the cost per person.
Details: Jaszia Lindon, Training Administrator, 0870
010 7088.
New chiefs plans
The new chief executive of the charity which helps
families who care for children with a disability or
special need brings extensive experience in the par-
liamentary and public affairs field to her role.
Francine Bates plans include the expansion of advice
and information services to parents and professionals.
She is also particularly looking forward to the imple-
mentation of legislation which brings forward new
entitlements for carers of disabled children in the field
of social care and special needs education. On the
health front, we are working closely with NHS Direct
Online and will be launching our new directory of spe-
cific conditions and rare syndromes in January 2001.
Contact a Family, tel. 020 7383 3555,
www.cafamily.org.uk
groups
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 4
e have been carrying out a
research project looking at
the efficacy of speech and
language therapy with peo-
ple with learning disability
and sensory impairment
(Griffiths and Gedling, 1999). Research suggests
the incidence of visual and hearing problems in
people with learning disability is high, particularly
those with Downs syndrome (Yeates, 1989; Kwok
et al, 1996; van Schrojenstein Lantman-de Valk et
al, 1994). A large study of 45,000 adults indicates
a prevalence of sensory impairment among adults
with intellectual disability comparable to or
greater than that found in the general population
and that these sensory deficits occur with increas-
ing frequency with advancing age (Janicki and
Dalton, 1998). Research also indicates that carers
are not reliable in identifying these deficits (Haire
et al, 1991) and that there is a need to heighten
awareness among staff and other carers with
regard to vision and hearing problems and the
consequent problems which may develop in inter-
personal communication and adaptive function-
ing. Aitken and Buultjens (1992) also point out
the effects on communication, including pragmat-
ics and non-verbal communication, and many
studies further recognise the changes in behav-
iour that can occur (Stafron, 1995; Castane and
Peris, 1993).
Part of our work is with people with learning
disability who attend a Day Centre. We felt the
focus of our intervention should be social com-
munication skills and targeted three common
areas we deemed feasible to work on with people
with a wide range of learning disability:
1. eye contact
2. initiation
3. turn-taking.
In our planning we considered the above research
findings: the high incidence of hearing / visual
difficulties, the effects of ageing, the need to
raise staff awareness, and the effects of sensory
W
A (sight and)
sound
foundation
We may be aware of the
effects of visual and
hearing impairments on
communication, but how
often do we routinely allow
for them when planning
therapy? Christine Griffiths
and Alison Gedling tell us
how small changes made a
big difference to their clients
with a learning disability.
Stage
1
2
3
4
Sensory experiences
Clients are provided with a range of sensory experiences through oral play.
Opportunities to:
a) initiate and maintain
* blow and suck
* oral motor and respiratory control.
b) adapt responses to activity demand with more control and consistency.
Oral toys are now chosen for the
* level of SSB synchrony they can facilitate; for example, a flute versus a kazoo.
* specific sensory experiences they can provide. For example, if a client has dif-
ficulty grading blow (that is, moving from hard to soft blowing), then oral toys
and sensory experiences which assist in this adaptation are made available.
Toys for facilitating grading of blow may include a range of bubble blowers,
peashooters, blow-darts/pens, flip-flap balls.
Appropriate support to achieve optimal functioning is also provided, such as
jaw support to encourage less bite and more lip closure/control on toys.
If the client is able to move from one adaptation to another, for example hard
to soft to hard blowing, then it is time to move on to sensory experiences that
reinforce the ability to
a) initiate and maintain
* oral and respiratory organisation at the same level; for example, when asked
to blow harder, the client can maintain oral control; when asked to change lip
posture, the client is able to do this without losing respiratory control - for
example, lips behind the mouthpiece of a trumpet versus lips over a trumpet.
* oral and respiratory control across oral play materials, that is, not losing the
level of control already achieved when moving from one toy onto another oral
toy, for example, from a penny whistle to a bubble blower.
b) modify the grading of suck and blow according to specific demands.
c) increase endurance and strength of suck, swallow and breathe.
Once SSB synchrony is achieved at most levels of demand and across a variety
of oral play materials - that is, it is an integrated, generalised skill - then it may
be appropriate to focus again on specific sensory experiences for the purposes
of sound system development. For example, encouraging sucking and experi-
mentation in the back of the mouth, to improve sensation to this area and to
prepare the client for establishing placement for the velar plosives /k/ and /g/.
Outcome
* Observations reveal the level to which the client can
initiate and maintain control of oral and respiratory
function under differing circumstances. As a result,
more specific input can now be planned.
* Clients are highly motivated for a range of experi-
ences with a wide range of oral play materials.
* Grading of oral and respiratory control may require
differing levels of support from the clinician.
* A specific response may only be achieved following
some attempts at achieving the target.
* If the client has difficulty initiating a suck, different
means for eliciting a suck are attempted. The ability
to initiate a suck should be established by the end of
this stage.
* Clients become more confident and are more likely
to seek different sensory experiences spontaneously.
* The client is now able to grade with minimal sup-
port from the clinician and usually as soon as a specif-
ic response is requested.
* For clients with difficulties initiating a suck, it may
be possible at this stage to move from drinking-based
suck to other suck activities, for example sucking on a
straw to move pieces of paper from one location to
another.
* The following are increasing:
==> Self-generated experimentation with oral play
materials.
==> Strength and endurance of oral and respiratory
control and coordination.
==> Ability to modify oral and respiratory control to
changing demands with speed and accuracy.
The sensory experience of the feature/s of a sound -
such as length (plosive vs fricative) - before that
sound is targeted, is likely to result in increased accu-
racy and speed of target sound production. This may
then generalise to sound production in words and to
other sounds with similar features.
Table 1: Stages of development in establishing and developing suck swallow breathe synchrony
sensory integration
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 10
Functional change
Using this approach over a five year period, I have
found that, by developing SSB synchrony with
children with speech disorders (particularly motor
speech disorders such as developmental verbal
dyspraxia), more effective oral sensori-
motor planning and coordination has
resulted. Provision of appropriate and
high quality sensory experiences has
increased the clients ability to inte-
grate their sensory and motor respons-
es. The effect of the latter is to pro-
duce a marked refinement in oral
function both as a whole and for spe-
cific oral and speech movements.
Importantly, functional changes are
achieved without developing splinter
skills such as the ability to lick lips, and
in a setting where clients are not being asked to
produce oral motor or speech movements in isola-
tion (see case example).
Sensorimotor deficits potentially impact on oral
motor and sound system development and may
contribute to the continued presence of
speech/phonological impairments. The approach
presented in this paper may provide the basis for
the future development of assessments used with
speech disordered children. Certainly, interven-
tion strategies for speech disordered children pre-
senting with sensorimotor deficits can be
informed and challenged by the approach.
With many researchers agreeing that sensory
information or input is an integral part of move-
ment control and co-ordination (Van
der Merwe, 1997, p3), this approach
can potentially be used in the man-
agement of adult clients presenting
with speech motor difficulties, partic-
ularly where the sensory deficit is
clearly identified. The materials used
to facilitate SSB synchrony may differ
but the basic premise of utilising the
synchrony to elicit ever increasing
control and integration of oral motor
skills remains.
Future research into developmental
speech disorders should seek to
further investigate the relationship between
sensorimotor input deficits and motor/speech out-
put deficits.
provide diagnostic markers for the type and
level of sensorimotor breakdown in children pre-
senting with a range of speech disorders, particu-
larly motor speech disorders such as developmen-
tal verbal dyspraxia.
determine assessment techniques that more
directly measure sensorimotor skills of speech dis-
ordered children.
provide normative data regarding the develop-
ment of suck swallow breathe synchrony.
provide the evidence base to support the use of
sensory integrative assessment and intervention
strategies when managing developmental speech
disorders.
Olwen Pate is Principal Speech and Language
Therapist (Paediatrics) with Croydon and Surrey
Downs Community Health NHS Trust at
Sanderstead Clinic, 40 Rectory Park, Sanderstead,
CR2 9JN.
References
Ayres, A.J. (1979) Sensory Integration and the
Child. Western Psychological Services, USA.
Laurel, M. & Windeck, S. (1989) A Theoretical
Framework combining Speech-Language Therapy
with Sensory Integration Treatment. Sensory
Integration Special Interest Section Newsletter 12
(1) 1-5.
Oetter, P., Richter, E. & Frick, S. (1995) M.O.R.E.
Integrating the Mouth with Sensory and Postural
Functions. Hugo, MN: PDP Press, Inc.
Pate, O. & Pinkstone, M. (1996) Suck Swallow
Breathe Synchrony (SSB) and its Relationship to
Case example
Gary, 4.3 years, has a severe oral motor dyspraxia and phonological disorder. He
was seen intensively for nine 30 minute sessions. Prior to intervention, his oral
and respiratory organisation/control was limited and he was unable to suck.
During intervention, once he had mastered oral play materials that required
increasing levels of oral and respiratory organisation and coordination for blow,
he sought SSB activities that relied on the development of his suck. In the final
therapy sessions he was able to suck drink up lengthy tubing (one to two metres
long) while standing up. The latter entailed him coordinating his breathing while
maintaining suck over periods of up to three to four minutes. Following interven-
tion, oral motor assessment revealed there was an increase in Garys:
postural, head and neck stability and control.
jaw stability, allowing for isolation of oral movements.
respiratory control and coordination.
ability to initiate and sustain oral movements more effectively and to
coordinate oral movements with respiratory support.
Assessment of Garys sound system revealed his phonetic inventory and phonetic
distribution had expanded. These expansions were integrated into Garys system
in both an idiosyncratic and appropriate fashion, as would be expected for a
sound system that continued to be disordered.
Examples of word initial position changes
Target Pre Post Target Pre Post
House a Thumb n Ltn
Sun n tn Saucer a s7a
Clown n gn Sugar d: da
Sock q 7 Jam n n
Teeth i Li Zip I Ip
Chair a Mouth b n
Dress g Girl d grl
Examples of word initial cluster developments
Smoke na7 na Three i: wi
Snake neI7 sneI7 Sleeping i7pI eIpIn
Swimming InIn InIn Spoon u:n pu:n
Bridge bId bwId Sweeties i7i7 wIi
Flower :wa aw Sky daI LaI
Blue bju blu Green i:n qwin
Examples of other changes
Money nni ntni Baby bbi beIbi
Pushing p phIn Watch nw7 wL
Doll da dl Fork u
this approach
can potentially
be used in the
management of
adult clients
presenting with
speech motor
difficulties
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 11
sensory integration
Oral Sensory
Motor Control
and Speech
P r o d u c t i o n
Skills. Proceedings of the First International SI-
NDT Congress, Cape Town, South Africa.
Pinkstone, M. (1995) Suck Swallow Breathe
Synchrony: A single case study investigating the
relationship between oral sensory-motor control
and speech production in a dyspraxic child.
Unpublished project.
Selley, W., Ellis, R., Flack, F. & Brooks, W. (1990)
Coordination of sucking, swallowing and breath-
ing in the newborn: Its relationship to infant
feeding and normal development. British Journal
of Disorders of Communication 25 (1) 311 - 327.
Smith, A., Goffman, L. & Stark, R.E. (1995) Speech
Motor Development. Seminars in Speech and
Language 16 (2) 87 - 99.
Van der Merwe, A. (1997) A Theoretical
Framework for the Characterisation of
Pathological Speech Sensorimotor Control. In
McNeil, M.R. (Ed) (1997) Clinical Management of
Sensorimotor Speech Disorders. Theime, New
York.
Wolf, L.S. & Glass, R. P. (1992) Feeding and Swallowing
Disorders in Infancy, Assessment and Management.
Tucson, AZ: Therapy Skill Builders.
Reflections
Do I give sufficient
consideration to
the benefits of
input as well as
output therapy for
clients with oral /
speech motor
deficits?
Do I have the
range of equipment
necessary for
clients to develop
oral motor skills?
Do I explore the
potential of
theoretical
approaches
embraced by
related professions?
Do your clients want more speech work than your time allows? Carol Bishops clients did, so she
developed Speech Sounds on Cue. This CD ROM provides multimedia cues for 531 consonant/
vowel and consonant/vowel/consonant words covering 19 consonant sounds in initial position.
Carol, senior speech pathologist at the Aged Care Rehabilitation Unit in Hobart, Tasmania,
designed the software for adults with dyspraxia, but it may also be suitable for children with dys-
praxia or Autistic Spectrum Disorder and people with a hearing impairment.
Speech & Language Therapy in Practice has a copy of Speech Sounds on Cue to give away FREE
to a lucky subscriber, courtesy of its UK distributor, Propeller Multimedia Ltd. It normally costs 90
+ 5 delivery + VAT for single copies.
To enter, simply send your name and subscriber number / address marked Speech Sounds on
Cue to Avril Nicoll, 33 Kinnear Square, Laurencekirk AB30 1UL, tel. 01561 377415, e-mail avrilni-
coll@speechmag.com by 14th October, 2000. The winner will be drawn randomly from all valid
entries.
*The program is operated using a mouse, touchscreen or simple keyboard control.
Recommended specifications: IBM PC running Windows 95 and above. Pentium 200 Mhz with 32
MB RAM, 24 bit true colour, 16 bit sound card and speakers and 16 speed CD-ROM drive.
Will also run on Apple Macintosh G3, 32 MB RAM, System 8 or later, 16 speed CD-ROM.
Speech Sounds on Cue is available from Gordon Russell, Propeller Multimedia Ltd. P.O.
Box 27028, Edinburgh, EH10 6WD, Scotland, tel/fax. 0131 446 0820,
www.propeller.net/react
Do you want a comprehensive measure of language skills for
clients in the age group 6-21 years? The Clinical Evaluation of
Language Fundamentals (CELF) has now been adapted and stan-
dardised for use in the UK, and Speech & Language Therapy in
Practice has a copy to give away FREE to a lucky subscriber, cour-
tesy of The Psychological Corporation. It normally costs 345.20.
To enter, simply send your name and subscriber number / address marked CELF to Avril Nicoll,
33 Kinnear Square, Laurencekirk AB30 1UL, tel. 01561 377415, e-mail avrilnicoll@speechmag.com
by 14th October, 2000. The winner will be drawn randomly from all valid entries.
CELF-3
UK
is available from The Psychological Corporation, FREEPOST WD147, Harcourt
Place, 32 Jamestown Road, London NW1 1YA, tel. 020 7424 4456.
1. Entrants must subscribe personally or as one of a department to Speech & Language Therapy in
Practice, and only one entry per subscriber number is allowed.
2. Entries must be received by the editor on or before 14th October, 2000.
3. The winner will be randomly selected from all valid entries.
4. The winner will be notified by 21st October, 2000.
5. The winner will have access at work to suitable computer hardware.*
6. The winner will review Speech Sounds on Cue for Speech & Language Therapy in Practice by a date
agreed with the editor.
1. Entrants must subscribe personally or as one of a department to Speech & Language Therapy in
Practice, and only one entry per subscriber number is allowed.
2. Entrants must be registered speech and language therapists.
3. Entries must be received by the editor on or before 14th October, 2000.
4. The winner will be randomly selected from all valid entries.
5. The winner will be notified by 21st October, 2000.
6. The winner will review the CELF-3
UK
for Speech & Language Therapy in Practice by a date
agreed with the editor.
Win Speech Sounds on Cue
Win CELF3
UK
Congratulations to Carol-Anne Murphy who
won Clicker 4, and to Mrs L. Collier, Debbie Rai, Margaret Rooney and Hilary Jarvie who
won photocopiable resources from Black Sheep Press in the Spring 00 issue of Speech &
Language Therapy in Practice.
Previous winners...
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Colorcard resources
EDUCATION
All from Winslow
Pocket Colorcards
Early Objects, Early Actions, Early Sequences, Early
Opposites
19.95 for four
The best thing about these is their size as the playing-card
sized photographs fit inside fishing games and post-boxes
with ease! They have been produced especially for chil-
dren so the objects, actions, concepts (pairs of pictures
such as big/little) and sequences (three-part, for example
having a haircut) are all appropriate to this client group.
These are excellent value and a must for anyone working
with preschool or primary-aged children.
Whats Inside?
24.95
This set contains pairs of cards, one of which shows the out-
side of a container (such as a fridge, school bag, first-aid
kit) and the other its contents. Children enjoy using this
resource to work on vocabulary, categorisation, prediction
and descriptive skills and it will be most useful to therapists
working in mainstream and special school settings.
What Is It?
28.75
These are object photographs with two smaller pictures
that show parts of the object (a computer has smaller pic-
tures of the keys and the mouse) or the object from an
unusual viewpoint (a wellington boot is viewed from
below and behind). This provides effective but limited
ways to work on vocabulary, descriptive skills and spatial
concepts with school-aged children.
Sequencing Sounds
35.50
This activity involves matching sequences of sounds (sup-
plied on cassette tape) to pictures. The two and three-
sound sequences include eating crisps and scrunching up
the packet and playing a drum, xylophone and maracas.
Although useful for working on listening skills there are
limited ways in which this material could be presented.
Using Colorcards in the classroom
ISBN 0 86388 188 2 9.95
This book provides a practical collection of ideas for using
Colorcards (or similar resources) to develop listening and
attention, comprehension, vocabulary, expression,
sequencing, and social skills. The aim of each activity is
clearly stated along with suggestions for varying the level
of difficulty. The index allows you to select activities to
link in with the National Curriculum (Key Stage 1 and 2).
This book is most useful as a resource for teachers and
assistants working in mainstream or special schools but is
also worth a glance by speech and language therapists
looking for some new ideas.
Diane Stanger is a speech and language therapist with
Sussex Weald & Down NHS Trust.
Essential reading
Parkinsons Disease - Studies in
Psychological and Social Care
Ed. Ray Percival and Peter Hobson
The British Psychological Society, tel. 0116
254 9568
ISBN 1 85433 299 6 12.95
This interesting and readable book opens with an
excellent introduction to the nature and course
of Parkinsons Disease. The following chapters
represent a sample of recent research into the
needs of people with Parkinsons and those of
their carers and families.
The second half covers assessments and inter-
ventions including psychological groups, support
networks, communication, swallowing, and a
useful chapter on driving.
This book describes in detail the full impact of
Parkinsons Disease on peoples lives. It should be
essential reading for anyone who provides, or is plan-
ning to provide, a service to people with the disease.
Sue Chorlton is a speech and language therapist
at Weston General Hospital, North Somerset.
reviews
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 12
A revelation
Have I Got Views For You!
Joan Murphy
University of Stirling, tel. 01786 467645,
e-mail joan.murphy@stir.ac.uk
ISBN 1 85769 0990 25
For people with Motor Neurone Disease whose
ability to communicate is limited, this framework
to enable them to discuss their quality of life is a
revelation. As such it is very relevant to the
speech and language therapists work. The
instructions for its presentation to the MND suf-
ferer are clear. The delightful materials do not
take an inordinate amount of time to prepare.
As a retired speech and language therapist who
now works as a Volunteer Visitor for the Motor
Neurone Disease Association, my role is about
quality of life issues in particular. Thus I found
this easy to administer framework an excellent
way of helping sufferers reveal needs which
could not have surfaced in any other way.
A future edition could include details of the
Motor Neurone Disease Association as well as the
Scottish Motor Neurone Disease Association, as it
provides services and information for people liv-
ing in the rest of the UK.
I consider this package value for money and rec-
ommend it thoroughly.
Adrianne Marks is a retired speech and language
therapist, formerly at St Marys Hospital, London and
the Domiciliary Service of Parkside Health Authority.
REVIEWS. . . . . . . . . . . . . .
r e v i e w s
Help me Talk Right
How to Correct a Childs
Lisp in 15 Easy Lessons
(0-9635426-0-5)
How to Teach a Child to Say
the R Sound in 15 Easy
Lessons (0-9635426-1-3)
How to Teach a Child to Say
the L Sound in 15 Easy
Lessons (0-9635426-4-8)
Mirla G. Raz.
Gersten Weitz Publishers, tel.
(480) 951 9707,
www.speechbooks.com /
www.thinkingpublications.com
$32+shipping (each)
These three books are designed
so non-professionals can use them
under a therapists supervision. It
is not dynamic therapy - and the
sixteen small black-and-white pic-
tures per page are not inspiring -
but they are easy to follow with
useful trouble shooting sections.
They progress logically from
teaching tongue positions, to pro-
duction of each sound in isola-
tion, in different positions in sylla-
bles and words, then in sentences
and consonant blends and finally
carry-over into conversation.
However, placing the tongue
behind the bottom teeth for /s/ is
controversial and the emphasis on
motivating through monetary
gain questionable.
Another limitation is the
American vocabulary with which
most English children will be
unfamiliar. Most therapists
already have a wide range of
materials for these sounds. Given
budget limitations and the high
number of serious communication
disorders on most caseloads, I
would not recommend these
books for UK therapists.
Nevertheless it is useful to have a
relatively tailor-made package for
minor speech problems and they
are reasonably priced.
Janet Farrugia runs an indepen-
dent speech and language thera-
py practice in Bookham, Surrey.
Easy to follow,
but not dynamic
ARTICULATION
PROGRESSIVE NEUROLOGICAL
PROGRESSIVE NEUROLOGICAL
Easy to read and use
Cognitive Neuropsychology and
Conversation Analysis in Aphasia. An
Introductory Casebook.
R. Lesser and L. Perkins
Whurr
ISBN 1 86156 068 0 24.50
This practically-based workbook does not dwell
on theory and is easy to read and use. The aim is
to demonstrate how the integration of
Cognitive Neuropsychology and Conversation
Analysis can provide rationally motivated apha-
sia therapy. A basic working knowledge of the
approaches is assumed although brief overviews
of both are given.
The authors present six real case studies and
ask the reader to suggest initial hypotheses,
assessments, interpretation of results and
approaches to therapy. Photocopiable work-
sheets are provided. At each stage, the reader
can compare their ideas to those presented by
the authors. Answers are therefore provided
but the authors clearly expect and encourage
variations.
This book is a valuable and reasonably-priced
resource for aphasia therapists aiming for a
structured balance between impairment-
focused therapy and a more functional interac-
tion-based approach. It is designed to provide a
constant source of reference and would benefit
experienced practitioners, newly-qualified ther-
apists and students on placement.
Kit Barber is a specialist speech and language
therapist working with community-based adults
for North East Wales NHS Trust.
ADULT NEUROLOGY
Enthusiastic and personal
Reasons and Remedies
Patricia Sims
Mortimore Books, PO Box 156, Barnstaple,
EX33 1YN
ISBN 0-9536209-0-5
12.95 (10.95 if ordered directly)
Speech, language, learning and social prob-
lems, such as stammering, dyslexia and autism,
need no longer be puzzling. If we enquire in
some depth into the personality traits of young
children, we will discover mechanisms which lie
behind such problems.
In her long career with special needs children,
Patricia Sims has developed her holistic method
of working which she says has increased success
of therapy as well as her own job satisfaction.
The book includes a very comprehensive,
detailed checklist for case history taking and many
vignettes from cases to illustrate her theories.
A very enthusiastic and personal book. Easy to
read, it should stimulate creative thought, how-
ever experienced the reader.
Rosemary Fisher specialises in dysfluency in
adults and children. She works in Derby.
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 13
reviews
Raises awareness
Fragile X Syndrome - An Introduction
Fragile X Society, tel. 01424 813147
Video+booklet 5.00
This twenty minute video aims to help profes-
sionals know when to suspect Fragile X may be
present, understand its effects, and initiate early
multidisciplinary evaluation, intervention and
support.
Interviews with professionals and parents,
together with film of those affected, demon-
strate and explain the characteristics effectively.
The accompanying booklet explains more about
speech and language than does the video. The
many benefits and implications of diagnosis are
discussed, and there is a positive emphasis
throughout.
A useful and good value resource to share with
colleagues, and to raise our own awareness of
the condition, the characteristics of which have
management implications.
Fiona Ashford is a speech and language thera-
pist working in the Special Needs Team in
Portsmouth Healthcare NHS Trust.
Enjoyable, with excellent
illustrations
More Than Words (Helping Parents
Promote Communication and Social Skills
in Children with Autistic Spectrum
Disorder)
Fern Sussman
The Hanen Centre; available from Winslow
ISBN 0-921145-14-4 26.95 + p&p
This is a valuable resource book for any therapist
who has contact with children with autistic spec-
trum disorder.
Following a similar format to the original
Hanen It Takes Two To Talk, it establishes the dif-
ferent stages of communication and essentials
for good communication (OWLing - observing,
waiting, listening - and additional new
acronyms) and then moves on to useful exam-
ples of how to develop play and share books or
music.
In addition, it addresses specific aspects associ-
ated with autistic spectrum disorder, such as
explaining sensory-motor preferences and the
way the children acquire information. Especially
useful are the examples of adapting language
and using augmentative communication.
A well-priced, easy and enjoyable read with
excellent illustrations, it has well structured
examples of functional ideas for parents to try.
Fiona Coughlan works for Warrington
Community Health NHS Trust with preschool and
primary school children with special needs.
AUTISTIC SPECTRUM
Informative and inspiring
Fluency courses at the Apple House,
Oxford, 1966 - 1998 - An Evaluation
Dr Rosemary Sage
The Stammer Trust
ISBN 0 9534807 0 4 7 inc. p&p
This clear, readable account of thirty years of
evolving stammering therapy at Apple House
begins with a succinct history of stammering and
goes on to give brief summaries of recent
research. Results of different approaches to ther-
apy are included and discussed.
The second half concerns itself with the numer-
ous aspects of running the courses at Apple
House. Four case histories are included with a
summary and evaluation of the therapy program.
This report combined the scientific with the
therapeutic in an informative and inspiring for-
mat. The richness of the therapists and clients
experiences was quite enviable. This report is
excellent value for money and I recommend it to
students and therapists alike.
Amanda Mozley is head speech and language ther-
apist at Chelsea and Westminster Hospital, London.
Invaluable software
Boardmaker
Mayer-Johnson plc
250 plus VAT
Available for Apple Macintosh or Windows
Version evaluated: Boardmaker for Windows
This computer programme, containing over 3000
picture communication symbols, allows you to
make attractive communication boards and dis-
plays suitable for use with children and adults. It
comes with a clearly written users guide and an
excellent 60 minute instructional video.
With the programme you arrange cells - boxes
in which you place picture symbols - anywhere
on a page; make them different sizes; change
their border colours - useful if you want to say
colour code nouns and verbs; display text with
your symbol in up to two languages -
Boardmaker comes with ten; plus you can add
your own text and other language fonts. You
can also make your own symbols or bring pho-
tographs into the programme.
As with any programme there were one or two
initial headaches in using it, and some of the sym-
bols arent quite appropriate for the UK; for exam-
ple the word goal produces a picture symbol quite
unlike any set of goal posts Ive seen in this country.
Verdict: an easy to use and invaluable piece of
software which produces attractive materials.
Neil Thompson is a speech and language thera-
pist in mainstream schools and schools resourced
for children with medical needs/physical disabili-
ties. He works for Newham Community Health
Services NHS Trust, East London. He won
Boardmaker in the Winter 99 reader offer of
Speech & Language Therapy in Practice.
DYSFLUENCY
LANGUAGE DEVELOPMENT
CHILD DEVELOPMENT
SYNDROMES
or the past six years the Department of
Human Communication Science at
University College London (UCL) has been
developing an approach to speech and
language therapy students professional and clin-
ical learning which emphasises active participa-
tion from the earliest stages of clinical placements
(Morris, 1998; Parker & Kersner, 1998). We have
been moving towards emphasising reflective
cycles of learning which integrate practice, theory
and rehearsal, rather than the traditional linear
model with its expectation that theory and obser-
vation should always precede practice (Schon,
1983, 1987; Kolb, 1984; Stengelhofen, 1993;
Morris & Parker, 1998). Speech and language ther-
apy students reported experience of learning
more effectively through active participation is
supported by Erauts work on the relationship of
practice with theory in professional learning (for
example Eraut, 1994). Real responsibility helps the
development of confidence and allows students
to gain a deeper understanding of related theory
(Kersner & Parker, 1999).
One application of this approach has involved a
partnership with the Stroke Association Dysphasia
Support Service in London. The placement was
first set up in 1997, and is completed by under-
graduate Speech Sciences students as a prepara-
tion for their main final year placement with
speech and language therapy services for clients
with acquired disorders of speech, language and
cover story
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 14
Read this if you:
want innovative
ideas for training
believe student
training should
also benefit
clients
are interested in
working with the
voluntary sector
Research shows individuals learn more
effectively when given responsibility and
encouraged to participate actively. Suzanne
Beeke and Ann Parker are behind an innovative
programme where speech and language
therapy students become temporary volunteers
for the Stroke Association. Here, they explain
how this has benefited the people living with
dysphasia as much as the students.
F
voice. The design and organisation of the place-
ment has just been revised in the light of an audit
carried out in the summer of 1999.
Students are assigned, in pairs, to work with one
of the London Stroke Associations Dysphasia
Support groups, which are affiliated with the
Stroke Association Dysphasia Support Service. The
dysphasia support organiser acts as their supervi-
sor for the duration of the four week placement.
Non-local speech and language therapy supervi-
sion is provided by a member of the clinical staff
at UCL.
Support and practice
Each pair of students assists the dysphasia support
organiser in planning and running the weekly
stroke group, and also makes visits to certain
group members who have requested that a
Stroke Association volunteer visit them at home.
Each pair of students visits two people twice a
week for approximately one to one and a half
hours per visit. During this time students work as
Stroke Association volunteers, fulfilling the objec-
tives of the Dysphasia Support Service by provid-
ing support with, and practice of, communication
for the stroke person in their own home (The
Stroke Association, 1999). Verbal and written
information which clearly states that students are
not qualified or expected to provide speech and
language therapy is given to the dysphasic indi-
viduals, their family members, the dysphasia sup-
port organiser and the students before the place-
ment begins. The programme specifies that stu-
dents must only visit individuals who are not
being treated by a speech and language therapist
during the time when visits will take place.
The placement aims for students to:
1.develop the ability to interact with adult
clients
2. experience working as a volunteer within a
community-based service for clients with
dysphasia
3.be aware of the psychosocial and practical
aspects of life for people with dysphasia, and
for their families
4.develop a problem-solving approach to
clinical work
5.continue to develop independent learning
skills
6. enhance the ability to seek and act on
feedback on performance from a range of
sources, including the client, family members
and professional colleagues
7.enhance the ability to take responsibility for
day-to-day organisation of home visits,
session planning, administration tasks and
report writing
8.continue to develop pair-work skills
9.experience a model of clinical supervision
other than the traditional one-to-one student
and speech and language therapist approach.
Comp
confid
and
comm
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 15
cover story