Spring 2003

Articles from the Spring 2003 Issue

Prime and Predigest.

Nicoll A. (2003)

It is a truth universally acknowledged that a speech and language therapist in possession of a good idea must be in want of a publisher, as Jane Austen might have said. This article, sprinkled with apt quotations from “Pride and Prejudice”, suggests that getting your work on paper requires the single-mindedness of a Mrs Bennet, the determination of a Mr Darcy and preferably the liveliness of a Lizzy – but, thankfully, not the skill of the Pride and Prejudice author.

From reaction to action.

Dobson S. (2003)

If referrals for feeding and drinking difficulties in adults with profound and complex needs are made too late or in too great a number for the speech and language therapy service to respond immediately, the problem becomes one of dysphagia and is much more difficult to manage. This article describes the background of difficulties which led to a more preventative approach that has been applied in Bradford. The team concentrated on the largest special care unit where 32 people are fed out of the 45 attending on a weekly basis, using a questionnaire jointly designed with participants and detailed observation of each individual. The audit identified key clinical factors (which are listed). The audit has led to a change in approach and a broader clinical focus on general factors not usually considered by speech and language therapists, such as bowel function and oral infections.

Only a story?

Shanks B. (2003)

Once upon a time, a fairy godmother (in her day job as a speech and language therapist) weaved her magic on children in Stockport schools. From that day (actually, eight weeks) on, the children were never short of a story again, and they all lived more happily ever after. The eight week intervention took place in schools in areas of considerable social deprivation, and was supported by four hours of learning support assistant time per week for the eight weeks. A pilot study of 30 children demonstrated striking improvements in narrative ability when the children were retested following a three month intervention using the Renfrew Action Picture test and the Bus Story. Following the success of the pilot study, the local authority agreed to fund two further sessions as long as schools funded the learning support assistant. A further three schools have received intervention, and two schools have decided to use the narrative approach across the whole of key stage 1. The proven links between oral narrative ability and future academic success support the view that therapy is best delivered as part of the curriculum with teachers and therapists working together to meet the needs of language impaired children.

Sensible solutions or daft ideas: a search for answers.

Taylor P, Stansfield J (2003)

Ethical principles need to be interpreted rather than just applied in our work. When a 73 year old man uncharacteristically asked for assistance with his communication, in relation to giving a speech at his golden wedding, the authors used an ethical framework to identify what the speech and language therapy role should be. To the golden rule of ethics – beneficience, non-malificience, autonomy, justice – is added another: communication need. This article describes the four levels of approach and principles in relation to this case. The background, immediate and long-term communication needs, suggested solutions and outcomes of the intervention are discussed.

Working with bilingualism: the aim of our care.

Chavda P, Helsby L. (2003)

The advantages of bilingualism are such that a speaker’s overall competency may be more than a sum of parts. This article reports that recognising and facilitating this in group therapy not only has benefits for the children concerned, but brings parents and other staff on board too. Language groups were run in Leicester for two groups, each with 7 boys, with a bilingual background of English and Gujarati spoken at home. At the start of the groups the parents completed a questionnaire which looked at their expectations and their understanding of language issues. The structure and activities of the therapy sessions and homework (translated into Gujarati for parents) are described. Children were encouraged to access and name items in both languages and to use home language outside the home setting.

Barbie and Ken: an unequal relationship.

Earle S. (2003)

When you see a little boy who can’t sit still, when you are referred a middle-aged female with dysphonia, when you visit your GP, do you question whether gender might be influencing the treatment you give and receive? The issue of gender, the consequence of socially ascribed differences, is discussed in this, the second of four sociological perspectives on inequality. Differences in morbidity, educational achievement, schooling and the therapeutic relationship are in speech and language therapy are examined.

How . . . I am negotiating care pathways.

Unblocking the pathway.

Smith N. (2003)

Too often speech and language therapy and other services are difficult for clients to access and negotiate, and therapists themselves are not always clear which way to turn. Do care pathways offer a way ahead? Care pathways are becoming familiar as a way of describing, planning and mapping a client’s journey via different routes from referral to discharge. Depending on the nature of the client’s needs this journey may be through speech and language therapy only, or involve a range of health and associated services working together with the client and family. But how do we know this isn’t yet another fad? Are there practical benefits for client and services? Do care pathways help us to achieve evidence based practice? And how do we ensure that a care pathway offers access for all, and isn’t a euphemism for ‘passable with care’? Two companion articles explore the issues. This article describes the development of a specialist service for children who stammer, based on three sessions a week. This care pathway for dysfluent children could be equally applied to other communication difficulties which have a low incidence in community caseloads but need targeted and timely intervention.

Which way now?

Yardley C. (2003)

Dissatisfaction with the time, resources and evidence available for therapy for people with aphasia is widespread. This article reflects on Speakability’s 2002 Mary Law Lecture and argues thatr, when specified within a care pathway, communication difficulties such as aphasia become measurable and can therefore attract resources and provide consumers with ammunition to press for improved services.

My top resources.

Howarth R. (2003)

The author works both in an acute children’s hospital as well as providing a community service to preschool children with feeding and swallowing difficulties as part of a multidisciplinary team. Resources include a stethoscope, Evans blue food dye, equipment in the form of special cups, bottles and teats, textbooks, and colleagues.