Autumn 2009

Articles from the Autumn 2009 Issue

Scoping and scaling

Kirsty Hydes & Paula Leslie

The evidence-based pilot of an endoscopy rating scale for use with people with dysphagia

While the endoscopy swallow assessment is within the scope of practice for speech and language therapists with expertise and specialist training in dysphagia, the profession lacks an endoscopy rating scale. Such a scale, based on clinical practice and supported by robust evidence, is needed to measure and improve reliability of the procedure. The authors explain how they developed and piloted a rating form by drawing on published reports and research about what can be seen during endoscopy and the relative advantages of different types of scaling, as well as expert peer review.  

The cost of care

Beverley Hopcutt with Hal Bailey

Twelve essential resources for working with people with motor neurone disease, in particular the Year of Care Pathway

Beverley Hopcutt considers how the Motor Neurone Disease Year of Care Pathway will help commissioners ensure interventions will be in place when needed so that the multidisciplinary team can spend more time with clients and plan to manage symptoms effectively. This is challenging but vital because of the rapid progression of the disease and the number of symptoms it can cause. Beverley looks critically at the cost provisions for speech and language therapy for management of communication, dysphagia and sialorrhea. She also interviews Hal Bailey, who has motor neurone disease, to find out how the Year of Care Pathway would have made life easier for him compared with the current system. Beverley then lists 11 other up-to-date resources which are an essential part of the speech and language therapy toolkit when working with people with motor neurone disease.

Conflicting ideas

Jo Middlemiss

Our life coach recommends taking a step back from workplace conflicts to find a creative and satisfactory solution

A survey sent out to a sample of readers included an open question about which concerns they would most like life coach Jo Middlemiss to address. Workplace conflict figured highly, whether involving relationships with clients, colleagues, the multidisciplinary team or management.  Jo reports on 5 conflict styles and suggests that, by thinking about the conflict style of yourself and others, a creative and satisfactory solution will emerge. 

Walking with Dobermanns (part 1)

Sam Simpson, Emma Gale & Ashleigh Denman

The impact of Dr Mark Ylvisaker’s ideas on practice with people with brain injury, and the implications for other difficult-to-serve client groups

This is the first of two articles inspired by the work of the late Mark Ylvisaker. While the authors describe how he inspired them to develop a practical, holistic, integrative approach to brain injury rehabilitation, they stress the applicability of these ideas to therapists working in many fields with clients of all ages. Ylvisaker reverses the traditional hierarchy of therapy, which moves from impairment through activity to a later focus on participation. His range of interventions focuses on goal setting, group and individual project work, use of metaphor and identity mapping. In this article, Sam Simpson explains how she put the ideas about identity reconstruction into practice with a recent client, PJ. The second article in the Winter 09 issue will cover project work. 

This House Believes in e-stim

Christine Matthews & Paula Leslie

Evidence based debate: is NMES / e-stim effective in treating people with dysphagia?

This is the third in our series of articles set out like a debate, with the Proposition required to prove its case and the Opposition aiming to show why the Proposition is wrong. The Proposition case is that transcutaneous neuromuscular electrical stimulation (NMES / e-stim), in conjunction with traditional swallowing treatment techniques, is an effective treatment for dysphagia and is supported by patients. The Opposition points to the lack of quality evidence that NMES has positive effects on swallowing function and to further evidence that, worse than no effect, it may increase a patient’s risk of aspiration, which is unacceptable. Based on the available evidence, the authors conclude that it would currently be unethical to support the use of NMES in dysphagia treatment. 

How I help people move on (1): Steering the way home

Sue Martin & Magda Pearson

Creative and dynamic support to prepare people with severe and profound learning disabilities for a house move

The authors were asked by the manager of a local day service to develop a meaningful and interactive way to convey the concept of moving house to a group of people with severe and profound learning disabilities. Speech and language therapist Sue Martin and drama therapist Magda Pearson based their 12 week programme on Keith Park’s Story Telling work. They hoped by providing familiarity with the experience to help the service users understand and be less anxious when the move actually happened. The process involved the development of communication profiles for each client, writing verses and choosing Objects of Reference for the 6 identified stages of the move and recording the clients’ responses. The authors reflect on the impact this work has had on their practice.

How I help people move on (2): Talking flats

Maria Venditozzi

Using the Talking Mats framework to ensure the wish of a lady with learning disabilities to live in her own home was respected 

Maria Venditozzi was asked to evidence the capacity of a lady with learning disabilities when her family questioned the validity of her decision to move into her own flat. Using the Talking Mats communication framework and comprehensive recording (photographs, audio recordings, video recordings), the lady was able to express the complexity of her emotions and her decision-making skills. This ensured she was able to move into her own flat as she wished. 

Our top resources – specific language impairment

Sandra McKeen, Toddy Lawson, Bernadette Bannon & Ruth Wallace

Ten of the most useful resources for working with school aged children with specific language impairment

The authors work with children with specific language impairment in two speech and language classes and their local schools in Fife, as well as providing advice and support to community therapists. Their highly practical top resources include Cued Articulation, De Bono’s Thinking Hats, and modified Colourful Semantics.