Autumn 2003

Articles from the Autumn 2003 Issue

Taking the long view.

Shah Y. (2003)

Even when enthusiasm, cooperation and support from the top are available, changing a culture isn’t easy. This article reports on the successes and what is still to be achieved following the introduction of a Focused Interaction programme to a Day Opportunity Service for people with severe learning disabilities. The Focused Interaction project combines intensive interaction, facilitating the development of social and communication abilities, and individualised sensory environment therapy to develop purposeful interactions with the environment for three service users on a daily basis. Staff training, the use of questionnaires for recording users’ responses and the subjective impressions of staff, and feedback sessions are described. The introduction of agency staff has led to disappointing return rates for data forms, so that the plan is that all agency staff will now be trained in Focused Interaction lessening the need for intensive involvement of speech and language therapy services.

A bright SPPARC.

Armstrong L, McGrane H. (2003)

Supporting Partners of People with Aphasia in Relationships and Conversation (SPPARC) was developed in London and is a proven method of improving interpersonal communication. SPPARC brings together carer support and conversational analysis. This article describes a project which investigated whether these positive findings could be replicated in a rural area where distance and population density are different. The first half of the 28 once weekly sessions provides participants with information and support on stroke and aphasia. The second part aims to increase knowledge of conversation, including the use of video recordings. Twenty carers were invited to participate of whom ten were unable to attend through employment and other commitments. Two groups were set up, one in a town with good transport services, and the other in a small rural town. Only two of the carers and their partners were willing to video themselves and one of these was unrepresentative of normal conversation, so video clips from the programme were used to illustrate and facilitate more effective two-way conversation. Evaluations were very positive about the benefits of SPPARC. As a result of the project a monthly evening carers’ group has been set up for those who attended as well as others who were unable to attend the daytime programme.

Functional communication: the impact of PECS™.

Heneker S, Page L M. (2003)

The Picture Exchange Communication System (PECS™) aims to teach individual users to initiate communication. The effectiveness of introducing this approach to whole classes within a school for autistic spectrum disordered children was investigated in two groups. Class staff and parents attended a formal PECS training course and the impact on the amount, functions and method of communication and the level of adult support required were recorded. Observations were carried out in four different contexts: free play, snack, swimming and structured teaching. For group 1 children, aged 6 to 8, the amount of communication increased in all activities apart from swimming. Requesting was the most frequent function at both base-line and follow-up. The most frequently used method of communication at base-line was by symbols. At follow-up symbols was the main method for snack and structured teaching and physical communication was predominant for free-play and swimming. The presence of an object/event was the main level of stimulus to which children responded for all activities. For Group 2 children, aged 9-10 years, total communicative acts increased for all activities apart from structured teaching, where the decrease may have been due to their being taught more independent skills of commenting for the first time. Requesting remained the most frequent function of communication, and more formal means of communication were observed. The presence of an object/event remained the main stimulus for snack and swimming, but more independent responses were seen in free-play, with the presence of a listener becoming the level of cue required to initiate communication.

Ethnicity and culture: an unequal power.

Earle S. (2003)

While defining ethnicity is complex, research studies demonstrate that there is wide-ranging discrimination against minority ethnic groups and cultures. The heterogeneity within ethnic groups is noted, differences in disease incidence in different minority groups is examined, and racism and discrimination leading to poorer quality care for minority groups is demonstrated. Assumptions about English and the use of minority languages and the role of genetics and cultural variation in disease incidence are discussed, as well as the role of poverty and social exclusion. The relevance of all these factors to speech and language therapists in planning provision for stroke rehabilitation, differences in language development, and power relative to their clients is examined with a view to helping reverse such discrimination.

Altered perception.

Lee G (2003)

How do people who stammer think others perceive them, and are they right? Do people who don’t stammer find everyday speaking situations as easy as people stammer seem to think? This article describes a small-scale survey of personality traits associated with people who stammer and a second survey which investigated how easily people who don’t stammer deal with common speaking situations. Positive and Negative traits related to confidence, embarrassment, social disability, incomprehensible speech, fear, ignorance, and socially restricted life were rated by ten dysfluent clients and as predictions of attitudes of non-stammering people. Forty non-stammering people also completed the rating scales. The results showed that people who stammer had a tendency to think other people’s view of them was much more negative than it actually was. The survey of perceptions of difficulties associated with the use of the telephone in different situations and speaking in different contexts revealed that perceptions appeared to match reality, with little difference between the two groups. The results have proved to be a useful therapeutic tool in encouraging a change in perception in clients who stammer.

How . . . I put research into practice.

Gathering the evidence.

Soloff N. (2003)

‘Evidence based practice’ sounds good, but updating our practice as new information becomes available is not always easy. The unwieldiness of public services, long waiting lists and lack of time to research the research can all conspire against us. In the Spring 2000 issue, three contributors discussed how they put practice into research. Then we observed that speech and language therapists “want to know optimum times for intervention, techniques that produce results and caseload organisation that makes the best use of limited time”. So, once we know, how do we change our practice accordingly? Three papers present the case for evidence based practice. In this first article, we are told that research isn’t confined to ivory towers or weighty journals, and we are challenged to ask, investigate, discuss and share the everyday questions that add to the evidence base for our practice. Questions arise in everyday practice and should be noted down for examination at a more convenient time. Advice is provided about access to abstract publications and databases, library facilities, journal alerts and RCSLT clinical guidelines. Tips on appraising the research evidence, and core skills and attitudes towards existing knowledge and accepted practices is given.

Weighing the arguments.

Glogowska M, Dobinson C, Wren Y, Hayhow R, Wade J, Roulstone S. (2003)

Six researchers at the Speech and Language Therapy Research Unit pause among their protocols to reflect on their research. All practising clinicians in a previous or parallel life, they describe what impact their research has had on their approach to practice. Interviews with the parents of speech/language delayed children and with clients with aphasia have altered approaches to treatment for two of the researchers. The need to motivate cooperation and commitment when working in partnership with primary schools is emphasised, as well as the difficulties in adhering to research protocols are described as well as the overuse of feedback in clinical practice.

Setting yourself free.

Nicoll A. (2003)

Susie Parr and Carole Pound from the London Connect Centre are at the forefront of aphasia research. Avril Nicoll caught up with them at an Aberdeen study day on improving services for people with severe aphasia. This article contemplates the opportunities we all have to put their research into practice, whatever our client group. The impact of severe aphasia on the patient is social exclusion. This is illustrated by the example of one patient from a group of 19 studied. Conditions for participation and inclusion need to be created as well as supporting change in communication skills. The approach of the London Connect Centre to rehabilitation is described.

My top resources.

Leslie P, Meek P. (2003)

The importance of evidence based support for therapeutic intervention is increasing, hence the authors believe the divide between the clinically based researcher and the research-trained clinician must shrink. Many of the skills and resources listed on this page should be part of everyday therapist life, and available in all clinics. The resources mentioned include Endnote, other speech and language therapy researchers, supervisors, IT training, computers, key people, IT people, the Internet, a space of your own and personal skills.