TRANSCRIPTION / IN BRIEF

Grunwell, P. (1985) Phonological Assessment of Child Speech (PACS). Windsor: NFER-Nelson. Haigh, C. (2009) Editorial: Embracing the theory/practice gap, Journal of Clinical Nursing 18(1), pp.1-2. Hewlett, N. & Waters, D. (2004) Gradient change in the acquisition of phonology, Clinical Linguistics & Phonetics 18, pp.523-533. Howard, S.J. & Heselwood, B.C. (2002) Learning and teaching phonetic transcription for clinical purposes, Clinical Linguistics & Phonetics 16(5), pp.371-401. International Phonetic Association (2005a) The International Phonetic Alphabet (Revised to 2005). Available at: http://www.langsci.ucl. ac.uk/ipa/ (Accessed: 11 August 2011). International Phonetic Association (2005b) extIPA Symbols for Disordered Speech (Revised to 2002). Available at: http://www.langsci.ucl. ac.uk/ipa/ (Accessed: 11 August 2011). Louko, L.J. & Edwards, M.L. (2001) Issues in collecting and transcribing speech samples, Topics in Language Disorders 21(4), pp.1-11. Maben, J., Latter, S. & Clark, J.M. (2006) The theory-practice gap: impact of professionalbureaucratic work conflict on newly-qualified nurses, Journal of Advanced Nursing 55(4), pp.465-477. Nunes, A. (2011) A question of scale, Bulletin of the Royal College of Speech & Language Therapists September, p.11. Powell, T.W. (2001) Phonetic transcription of disordered speech, Topics in Language Disorders 21(4), pp.52-72. RCSLT (2010) Guidelines for Pre-Registration Speech and Language Therapy Courses in the UK (Incorporating Curriculum Guidelines). Available at: http://www.rcslt.org/about/work_with_ educators/curriculum_guidelines (Accessed 11 August 2011). Swain, J., Pufahl, E. & Williamson, G.R. (2003) Do they practise what we teach? A survey of manual handling practice amongst student nurses, Journal of Clinical Nursing 12(2), pp.297-306.

In Brief...
Apraxia of speech diagnosis: opening the can of worms
Jon Hunt argues that we need to be clearer in differential diagnosis of phonological and articulatory difficulties underlying what we refer to as apraxia of speech.

supported by

this suggests a discrepancy. If they cant, this could again point to a phonological problem. Similarly with syllable number judgement. Does it matter if we get it wrong? Is articulatory therapy necessarily invalid if a problem is more phonological? Well, thats another debate, but at least its good to be as clear as we can be about what were dealing with. Jon Hunt is a speech and language therapist with North Bristol NHS Trust.
References Darley, F.L., Aronson, A.E. & Brown, J.R. (1975) Motor Speech Disorders. Philadelphia: Saunders. McNeil, M.R., Robin, D.A. & Schmidt, R.A. (1997) Apraxia of speech: Definition, differentiation, and treatment, in M.R. McNeil (Ed.) Clinical management of sensorimotor speech disorders. New York: Thieme (pp.311-344).

REFLECTIONS DO I PROVIDE A GOOD ROLE MODEL FOR STUDENTS ON CLINICAL PLACEMENT? DO I DRAW ON THE SPECIALIST KNOWLEDGE OF COLLEAGUES WHEN APPROPRIATE? DO I USE ANY TEACHING MOMENTS TO THINK ABOUT MY OWN PRACTICE?
How has this article changed your thinking? Let us know - see information about Speech & Language Therapy in Practices Critical Friends at www.speechmag.com/About/Friends.

hen we describe someone as having apraxia of speech, what are we effectively saying? Most speech and language therapists would agree that in issuing this diagnosis we are claiming that the person in question has a difficulty with motor programming, that is the ability to place the articulators in such a way as to represent the intended sound sequences. In other words we are claiming that the person is demonstrating a discrepancy between the sound of the word in their head, and what comes out of their mouth. In psycholinguistic terms, we are claiming that there is a discrepancy between phonological output and articulatory output. Making this claim implies that we have evidence that the person has the sound of the word(s) correctly represented in their head or at least more correctly than the spoken output would suggest. At present in speech and language therapy we tend not to make any effort to substantiate such claims. We base our apraxia of speech diagnoses on overt speech behaviours such as sound mis-selection and groping, and on awareness of errors. These criteria were initially proposed in the 1970s by Frederic Darley and his colleagues, who arrived at their symptoms of apraxia of speech by taking patients whom they believed to have it and then describing their symptoms, an approach which McNeil et al. (1997) call experimental tautology. McNeil et al. argue that the vast majority of Darleys proposed (and still widely used) diagnostic criteria are invalid, since they are at least as likely to reflect phonological difficulties as articulatory ones. Darley and his colleagues stated that most if not all their subjects had aphasia as well as (allegedly) apraxia of speech. So how did they know which symptoms were due to which disorder? How can we tell if the underlying phonology really is intact? One way is to look at the effects of cueing. If the person is helped by cues which give no articulatory information, such as semantic, phonemic (unseen), closure or orthographic cues, then this points to a phonological instability. And if the person is an adult with good cognitive skills, try showing them pairs of pictures of objects which have names that either rhyme or dont rhyme. If they can judge which pairs rhyme but cant realise those distinctions in spoken output,

Research centre on the web

Wendy Best, Suzanne Beeke, Caroline Newton & Rachel Rees invite you to make use of the Centre for Speech and Language Intervention Research website for event information, making new contacts and accessing evidence based resources. ave you heard of the Centre for Speech and Language Intervention Research? We would like to give you an overview so you can see why it and its website may be of interest to speech and language therapists and their colleagues. The Centre is based in University College Londons Division of Psychology and Language Sciences. It focuses on research in speech and language disorders, with an emphasis on intervention and practical implementation. Members come from the UK and abroad, work in health and education settings, and their interests span developmental and acquired communication difficulties. The aims of the Centre are to: foster collaborative health service related research in the field of speech and language pathology and intervention disseminate current research information and encourage implementation in clinical practice foster partnerships in order to build research capacity across speech and language therapy centres be a resource for practitioners by providing access to web-based materials for use in assessment and therapy. We achieve these aims through holding regular events, disseminating research and resources via our website and through joint Higher Education Institution / National Health Service research projects. Our Doctoral students also have their projects linked to the Centre. Perhaps you or a colleague could come to a Centre event?

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SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2011

IN BRIEF

One lucky contributor in each issue receives 50 in vouchers from Speechmark, which publishes a wide range of practical resources for health and education professionals (www.speechmark.net).

Might a local initiative benefit from contact with someone carrying out current research in your clinical field? You can find the contact details of researchers conducting relevant projects on our website. Could your work benefit from a web-based resource? We have useful links to related websites and resources ranging from lists of minimal pairs to the Arizona Academy of Neurologic Communication Disorders & Sciences Aphasia Treatment website and SpeechBITE, the Australian searchable intervention database. If you are working with either adults with aphasia or children with specific language needs who have word finding difficulties, you might wish to access the cueing aid KeyPhone. Dr Carolyn Bruce devised the aid back in the 1980s when working with a man with aphasia who benefited from phonological cues and who could sometimes chose the correct initial letter for words he was unable to retrieve. Keyphone (a version of the aid by Dr Mike Coleman) provides the missing link turning letters into sound cues. It is possible to select the number of letters a client sees. There is evidence that it can be used effectively in therapy to improve word finding with adults (Bruce & Howard, 1987) and with children (Best, 2005). KeyPhone is free via the Centre website and has already had over 10,000 hits. Might it be useful for someone you are working with? We hope that you might access something of use to you via the Centre website, at an event, or by signing up to our newsletter (via the website). We also welcome applications for our part-time Professional Doctorate (www.ucl.ac.uk/slt/ research) for experienced therapists wishing to carry out research in their clinical setting. Wendy Best is a Reader, Suzanne Beeke the Research Department Head, and Caroline Newton and Rachel Rees lecturers at University College London.
Resource Centre for Speech and Language Intervention Research website, www.ucl.ac.uk/cslir/ References for cueing aid Best, W., Howard, D., Bruce, C & Gatehouse, C. (1997) A treatment for anomia combining semantics, phonology and orthography, in Chiat, S., Law, J. & Marshall, J. (eds.) Language Disorders in Children and Adults: Psycholinguistic approaches to therapy. Chichester: Wiley-Blackwell. Best, W. (2005) Evaluation of a new intervention for word-finding difficulties in children, International Journal of Language and Communication Disorders 40(3), pp.279-318. Bruce, C. & Howard, D. (1987) Computer-generated phonemic cues and effective aid for naming in aphasia, International Journal of Language and Communication Disorders 22(3), pp.191-201.

An encounter with Animal Assisted Therapy

As converts to Animal Assisted Therapy, Tim Grover and Sallie Bollans believe George Eliot got it right when she said, Animals are such agreeable friends - they ask no questions, they pass no criticisms...

hen approached by Occupational Therapy Technical Instructor Sallie Bollans, and asked whether I had any speech clients that would be appropriate for Animal Assisted Therapy, I didnt know quite what to make of it. Weve all heard of Dr Dolittle of course, but how Animal Assisted Therapy could benefit people with communication difficulties did not come to mind immediately! I asked Sallie to tell me more about it. She explained it is defined as a goal directed intervention where there is a specific therapeutic end in mind, where the animal plays a key role in meeting specific criteria (Gammonley et al.,1997). Sallie explained that Animal Assisted Therapy had been utilised as a treatment intervention within neurological rehabilitation at Chase Farm hospital since 2004, with the dedicated support of Pets As Therapy volunteer Paula Rowe and her English Setter / Collie cross dog Izzy. Sallie had also completed a training course (Companion Animal Interventions in Therapeutic Practice), delivered by The Society for Companion Animal Studies. Unlike in the community, functional goal setting can be more challenging in the inpatient environment as everyday interactions on the ward can be limited. As such, I felt that Animal Assisted Therapy might offer a new setting in which to work with patients away from the ward. What I didnt anticipate, however, was an activity in which patients felt comfortable to initiate and use their residual communication in a nonconfrontational environment. This stood in stark contrast to impairment based therapy which inherently confronts a persons deficits. Research has suggested that a dog may act as a unique catalyst to motivate the client to talk and provide an atmosphere of unconditional acceptance for the disordered speech that is produced (Macauley, 2006, p.8), and I observed this in a session when a patient with severely impaired comprehension and largely fluent empty speech proclaimed there, there, what a beautiful dog and later spontaneously produced language such as well done Izzy when rewarding with a biscuit. Research has also suggested that introducing a living animal into the therapy

session can result in patients feeling more at ease, more communicative and motivated to engage in therapy (Levinson,1962). Also simply stroking a dog has been shown to reduce high blood pressure (Odendaal, 2000) and increase levels of oxytocin (Odendaal & Meintjes, 2003). I recall one patient in particular, a great dog lover, who presented with relatively intact comprehension alongside telegraphic speech and articulation difficulties. In Animal Assisted Therapy, each activity with the dog elicited some appropriate spontaneous verbal output. For example, whilst grooming the dog, she would spontaneously produce soothing language: ahh, Izzy, beautiful! Furthermore, with direction, she could produce functional language to accompany an activity such as up and down, incorporating giving orders to Izzy, like wait, come here or sit. From a speech and language therapy perspective Animal Assisted Therapy offers a unique opportunity to work as part of a multidisciplinary team within a patient-led activity. The presence of the dog provides motivation for the client to work towards targets based around communication, physical, psychological and psychosocial goals in a fun and relaxed atmosphere. Since my involvement with Animal Assisted Therapy I have worked with other client groups including people with progressive neurological diseases. I believe that it is just as relevant for them and offers huge scope for providing stimulating, effective and enjoyable therapy. Tim Grover is a speech and language therapist, now at the National Hospital for Neurology and Neurosurgery. Sallie Bollans (email sallie. bollans@nhs.net) is an occuptational therapy technical instructor at Chase Farm Hospital.
Resources Society for Companion Animal Studies, www.scas.org.uk Pets as Therapy, www.petsastherapy.org References Gammonley, J., Howie, A.R., Kirwin, S., Zapf, S.A., Frye, J., Freeman, G. & Stuart-Russell, R. (1997) Animalassisted therapy: Therapeutic interventions. Renton, WA: Delta Society. Levinson, B.M. (1962) The dog as co-therapist, Mental Hygiene 46, pp.59-65. Macauley, B.L. (2006) Animal-assisted therapy for persons with aphasia: A pilot study, Journal of Rehabilitation Research & Development 43(3), pp.357-366. Odendaal, J.S.J. (2000) Animal-assisted therapy magic or medicine?, Journal of Psychosomatic Research 49, pp.275-280. Odendaal, J.S.J. & Meintjes, R.A. (2003) Neurophysiological correlates of affiliative behavior between humans and dogs, The Veterinary Journal 165, pp.296-301.

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