Articles from the Autumn 2008 Issue
The case for systematic long-term dysphagia review of clients with acquired physical and communication disabilities who have been discharged ‘nil by mouth’
Antonia Charalambos argues the case for systematic, long-term speech and language therapy review of clients who have been discharged from the service ‘nil by mouth’, particularly when they have physical and communication difficulties which make it difficult for them to make their wishes known. She cites two people whose review in these circumstances came about by accident. Through an educated trial and error approach, one is now on a full oral diet and one eats desserts. Antonia reflects on the wider impact this has had on their quality of life through enabling greater choice, interaction and independence. She suggests speech and language therapy review could be built in when a PEG (percutaneous endoscopic gastrostomy) feed is reviewed by a dietician, or a PEG tube by a medical team.
Gillian Lord & Karen Bailey
The impact on children with Down Syndrome, parents and clinical practice of a pilot Ready for Reading group for parents and teaching assistants
Young children with Down Syndrome have the potential to access language through reading from the time they understand 50 words. Gillian Lord and Alison Bailey decided to pilot a practical Ready for Reading group for parents and teaching assistants in Manchester. The group ran for 5 weekly sessions of 1 hour for five families. Each session covered a different aspect of reading and included a linked craft activity. Themes covered included pre-literacy skills, early reading skills and learning styles, including the benefits of errorless learning. Although there was no control group, the authors report on each child’s progress, the feedback from parents, and the changes they have subsequently made to their practice.
The impact that focus groups of people with communication difficulties following a stroke can have on a service
Health and social care policy emphasises the importance of listening to the views of users and carers about the services they need and want, but people with communication difficulties following a stroke typically have a limited voice. The East Sussex Speech and Language Therapy Service for Adults project saw Anna Hayes and colleagues use focus groups to seek the views of people with aphasia. The planning, process and outcomes are described. In particular, the project has led to increased funding for posts, a review of goal setting, improved ‘aphasia-friendly’ communication, more group work and a training pack. Other models for user involvement are being investigated.
Helen Francis & Joanna Lloyd
A joint ISE and sensory integration programme for a 14 year old with profound and multiple learning difficulties
Helen Francis is a speech and language therapist and Joanna Lloyd an occupational therapist at St Margaret’s School for children with profound and multiple learning difficulties and complex health needs. One pupil Mark John (then aged 14) had profound and multiple learning difficulties, sensory defensiveness and severe communication difficulties. It was difficult for him show preferences and for staff to understand his choice making. Helen worked with Mark John on an Individualised Sensory Environments programme, while Joanna carried out a programme of occupational therapy. With both feeling they had reached an impasse, they combined aims and set up a programme of joint working with Individualised Sensory Environments and sensory integration techniques. As this took effect and his sensory tolerance increased, Mark John was able to make progress with communication and life skills. In addition to joint working, the authors discuss the importance of using a sensitive measurement tool to identify targets and record outcomes.
Alison Roberts with more low-cost, flexible therapy suggestions suitable for a variety of client groups: ‘Standing in your shoes’, ‘Shadows’ and ‘Speedy categories’.
Life coach Jo Middlemiss advises on coping with the speech and language therapist’s common problem of an overfull car boot!
Kevin Borrett & Nicola Clark
Exploring reasons why some people who require AAC move successfully beyond simpler text-speech solutions to integrate high-tech computer-based communication aids into their lives
The Portsmouth and South-East Hampshire adult AAC service equipment budget has been funded since 2001. At that time, Lightwriters were the most popular loan item due to their straightforward text-based communication. Kevin Borrett and Nicola Clark consider how the priorities for the budget are changing now that high-tech computer-based aids which can integrate with environmental control systems are available. As these are not suitable for everyone, they look at three clients for whom higher-tech aids have been a success and consider how certain similarities around support, motivation, access and flexibility may be key factors.
Sam Simpson & Cathy Sparkes
In the third of a series of four articles on supervision, the focus is on the ‘nuts and bolts’ of roles, responsibilities and boundaries
In the third of a series of four articles on supervision, Sam Simpson and Cathy Sparkes outline overarching criteria to consider when setting up a supervisory relationship, including documentation, timing, location, personnel, funding, type and options for change. They go on to define three parameters – roles, responsibilities and boundaries – and emphasise the need to make these explicit at the outset of the supervisory relationship and at regular intervals throughout. They suggest two practical activities for readers to take the ideas forward.
How I take speech and language therapy into the classroom (1): Promoting pizzazz – and all that jazz
Playing a leading role in the classroom as a means of having more impact on the progress of children with specific language impairment
Collaborative working in the classroom has potential benefits for children, teachers and speech and language therapists of therapists. But while the ‘why’ was relatively straightforward, the ‘how’ posed a challenge for Kathleen Cavin. Reflecting that taking a leading role in the classroom might be one solution, she ran a small project over two terms with a class teacher, with the main focus on narrative and vocabulary work, specifically verbs. Preparation, target setting for the teacher and the children, session planning and outcomes for the children are included. Kathleen also considers how the experience has changed her practice, confirming for her that to be more of a therapist you sometimes need to become more of a teacher.
Karen Hayon & Evi Typadi
The impact of the ‘helicopter’ story telling and story acting technique on turn taking, listening and concentration of children with communication needs
As part of an Early Years Advisory Team early intervention project, Karen Hayon and Evi Typadi investigated whether the whole class ‘helicopter’ story telling and story acting technique (Gussin Paley, 1991) could develop children’s confidence, creativity and communication, particularly those with communication needs or English as an Additional Language. The ethos is child-centred and child initiated, with children dictating their stories – through play or talk – which are then acted out by the class. The project targeted children with particular needs and gradually introduced adult interaction targets as well. The progress of the children and adults is described, and Karen and Evi explain why they believe referred children need to be seen in their nursery context.
Approaches developed to support secondary school students with language and communication needs
Marysia Nash is a highly experienced speech and language therapist in Edinburgh who, together with a small team of colleagues, has developed approaches to support secondary school students with language and communication needs. Her top 10 resources focus on helping students with the enormous demands for vocabulary acquisition (the subject of her past research) while also highlighting the need for support in other areas such as reading comprehension. Particular attention is given to resources which facilitate collaborative working with teachers.
The development of a new type of care package offered for preschool children with language difficulties
In Summer 2006, staff in the Sunderland speech and language therapy service were dissatisfied with their service for children with language delay / disorder. At the time, children aged 2-4 were offered ‘active support’ appointments for children and parents and review appointment for monitoring progress. A small working group consulted colleagues, did a literature search and drew up an action plan. Penny Best describes the new pathway of care. This includes the parent and child attending a rolling programme of ‘Talk & Play’ sessions with other families in a local Children’s Centre, where the therapist rotates around each family. Additional parent-only groups have benefits but limited take-up. An audit of Talk & Play shows it has been accepted by parents and staff as a positive pathway.