Winter 2002

Articles from the Winter 2002 Issue

PECS appeal

Poole S. (2002)

The six stage Picture Exchange Communication System (PECS) recognises that a person may need more than social rewards to motivate them to communicate. This article redresses a lack of literature on the use of PECS with adults with a learning disability with a study of the use of PECS with David, a 27-year-old man with a learning disability and autism. PECS is a six stage structured behavioural programme. Stage 1 identifies a tangible reinforcer, something that the person finds motivating, such as a biscuit or ball, and a picture of this is obtained. The symbol is exchanged for the reinforcer to develop communication. Stage 2 involves increasing the spontaneity and physical range of communication. Stage 3 introduces the concept of choice; Stage 4 introduces sentences; In Stage 5 the person is taught to respond to questions, while Stage 6 introduces “I can see..” a less motivating sentence than “I want..” By the end of the programme, which lasted for one year, David was beginning to communicate spontaneously through speech and he seemed to be more aware of other people. A year later he is still encouraged to use and develop PECS through the encouragement of his sister.

Improving communication with EAZe.

Astin L, Roberts K, Withey E, Crawshaw M. (2002)

In common with other areas of the country, too many children in Bridgwater enter school with poor communication and literacy levels. This article describes an Education Achievement Zone programme which is working in partnership with teachers in eight mainstream schools to raise standards of achievement and opportunities for children through the acquisition and development of language skills in whole class situations. The aims of the programme are listed along with the speech and language therapy briefs for the first two years, and the questionnaire for teachers. Joint planning to link with the National Curriculum has been facilitated through supply teacher support paid for by EAZ. Co-teaching has provided the opportunity to introduce Somerset Total Communication practice for teachers. Plans include working with parents and developing parent-child interaction.

Communication – an inalienable right.

MacAulay F. (2002)

When patients recover consciousness in the alien environment of an intensive care unit, they may well feel that they have come from another world. Contact available through current alternative and augmentative communication methods in this environment has been limited. This article describes a three year collaborative research project to develop and test the ICU-Talk device for patients in intensive care. The first steps were to identify a suitable hardware platform and to develop computer software which was simple to use, easy to learn with minimal training, and specific to the needs of the ICU patient. The software includes a database of frequently-used phrases organised under eight topic headings developed with the help of ICU nurses. The device has been used with 21 patients over a 12 month period, most patients using it for 24 to 48 hours, since there have been no admissions of patients with Guillain Barre Syndrome or other alert, ventilated, intubated patients requiring prolonged care. Since ICU patients were unable to remember anything about using the ICU-Talk device or about their stay in intensive care the results presented are anecdotal – from nursing staff, observation, and automatic recordings made by the device. Two case examples of the use made of the device are given. The results suggest that the original device was too large and bulky and a smaller device has now been developed. ICU patients have difficulty in following instructions and tire easily. In addition, use of the ICU-Talk device was dependent on the cooperation of the nursing staff, and although they felt that communication with patients is important, they tended to complete nursing care routines before making the device available to patients. A proposal for funding of a multi-centre randomised control trial of the smaller ICU-Talk device in comparison with low-tech aids has been made.

Great idea – but how do we do it?

Money D, Thurman S, Parr J, Berry H, Stewart K, James L, Stephens J (2002)

Great government ideas can be quite a challenge to put into practice – particularly when accompanied by a short timescale. This article describes how the Trent Region special interest group worked on a consensus framework for developing communication strategies to benefit people with learning difficulties. Principles and processes agreed for each of the key elements of management, training, and networks and resources are listed. The definition of a communication strategy was a major task, and the resulting collaborative framework is given in the article.

Unemployable or unemployed?

Taylor K, Besser C. (2002)

The 1995 Disability Discrimination Act was meant to herald a new dawn for people with disabilities in the workplace, including those with aphasia. In reality the interaction of many factors influences whether or not an individual returns to work. This article describes a student research project which investigated factors which influence the ability of people with aphasia post-stroke to return to work, and what speech and language therapists can do to facilitate the return to employment. In-depth interviews were conducted with nine respondents with a wide range of working backgrounds. The main enabling and disabling themes are discussed, including attitude, communication factors, emotional factors, financial factors, physical factors, and people’s knowledge and understanding of aphasia. Self knowledge and awareness of strengths and weaknesses helps in enabling a successful return to work, although many factors are important and no single factor stands alone. Steps to better practice for speech and language therapists are listed.

Class of 2002: an unequal future.

Earle S. (2002)

We all hope for a long and fulfilling life with the opportunity to develop our particular talents. Yet our chances are unequal, and vary depending on our social class. In the first of four sociological perspectives on inequality, it is argued that, while we do need to develop an individualised, clientcentred approach, we must also be aware of how wider socio-economic and cultural factors influence our practice. Lower social classes experience higher rates of disease and have poorer educational and occupational success rates. Those living in the most deprived areas have the worst access to health care and have poorer diets. Possible explanations which have been put forward to account for these inequalities are examined. Government strategies have been implemented to combat inequalities in health and education. However, two of the most common problems for therapists are poor attendance and compliance. Some areas address this by refusing to accept clients after one missed appointment, but this merely serves to perpetuate inequality. Other methods of service provision may be required to effectively combat social exclusion. Some examples of good practice are listed.

How . . . I use therapeutic listening.

From sceptic to convert, the objective way. 

Treharne D. (2002)

What do we do when clients are making slow or no progress? When they have a variety of difficulties which interfere with their learning, communication and social skills? When it can be hard to put your finger on where things are going wrong? There is unfortunately no magic wand in speech and language therapy, but is our understandable suspicion of therapeutic listening programmes – which do things very differently – making us deaf to their potential benefits? In this article, the author explains how results from her research were so encouraging that she now uses The Listening Program as the first step for young people with auditory processing difficulties, ‘priming the system’ for more specific therapy programmes.

A.R.R.O.W. hits the bull’s-ear. 

Lane C. (2002)

This article stresses the importance of the self-voice to the A.R.R.O.W. (Aural, Read, Respond, Oral, Write) technique for improving listening, speech and literacy skills. Originally developed for children with hearing impairment, its use has extended across the community to include adults with aphasia, brain injury and learning disability.

Enthusiasm, knowledge – and a set of headphones. 

O’Connor K. (2002)

With 300 satisfied clients, the author needs no further convincing of the benefits of occupational therapist Sheila Frick’s Therapeutic Listening TM in helping children achieve their potential through individualised therapeutic listening programmes. Three short case studies are given, as well as a list of areas potentially affected by therapeutic listening.

My top resources.

Bowen C. (2002)

This article features the ten top resources of the Australian internet icon, Caroline Bowen, whose interests are largely to do with children’s language and speech sound disorders, family centered practice, continuing professional development, and technology assisted teaching.