Winter 2003

Articles from the Winter 2003 Issue

Continuing to climb.

Harris F. (2003)

Delegates at the Edinburgh European Congress were asked to consider the challenge of evidence based practice for the speech and language therapy profession. This article suggests four key messages were posed: 1 Evidence based practice is a process of different actions; 2. There are different levels of evidence; 3. The researcher may be a different person to the consumer of evidence; 4. Real evidence requires collaborative networks across our profession. Each of these points is discussed in relation to the issues raised by individual papers and poster presentations. The author came away with four challenges: 1. Who takes the lead at different points in the evidence based practice process? 2. How can collaboration be promoted between therapists and research teams? 3. How can the application of evidence-based ideas to practice be made more transparent? and 4. How can a cross-national discussion of ideas, evidence and practice be achieved? The sound-bite which summed up the context of the weekend was by Kath Williamson: ‘Evidence based practice should be a climbing frame and not a cage’.

Out of the frying pan, into the fire?

Portch A. (2003)

Discussions about clinic or school based therapy can get quite heated. The author warns that, by pulling out of clinics and concentrating on schools, the profession is in danger of getting its fingers burned. Instead we should be grilling ourselves about what combination is right for each individual, and what will enable us to continue giving an appropriate service to all children, irrespective of their age. Five principles are discussed: 1. What is the individual need?; 2. Who is the main focus?; 3. Why are we intervening?; 4. Proper procedures before arranging a school visit; 5.Collaborate and learn. The inclusive agenda for children with special educational needs to be educated in mainstream schools creates a challenge for both teachers and therapists. Success depends not only on selecting the right children but also learning and understanding the educational context, knowledge of the curriculum, and a staged approach to managing special educational needs via the new Code of Practice. Share/joint training is essential. A case example, school visiting example, and programme update are illustrated together with a list of resources for school age children.

From caterpillar to butterfly.

Middlemiss J. (2003)

The author, a Life Coach, believes that every challenge has a solution and that, ultimately, the only person you can change is yourself. This article challenges readers to unlock their potential and achieve their dreams. Every problem has a solution, and through coaching people can discover the rules and values that govern their lives.

Collaborating for communication.

Heins K. (2003)

In common with other therapists, the author and colleagues were looking for an efficient and effective way of managing clients with speech and language difficulties in mainstream schools. The result was the development of the ‘Collaborating for Communication’ project, which combines practical workshop training for teaching assistants with supervised practice involving groups of real children. Two schools at a time were targeted, visiting each school for one full day each week for five weeks. The project structure was an assessment and planning day for the first visit. Children with language difficulties were placed in groups of three to five children with one or two assistants allocated to each group. A different language area was targeted each week, covering understanding stories in the first week followed by building vocabulary, listening and following instruction, and telling stories in successive weeks. A sample session plan and work sheet are illustrated. Children needing phonology were seen in small groups with a teaching assistant. One hour workshops for teachers, teaching assistants and parents were organised, and three recently qualified therapists were invited to spend five days working on the project. At the end of the weekly visits each child received a report in standard format. Following the success of the first two terms other local schools were invited to a one day hands-on workshop at each participating school. Ten schools participated and, following the workshops, analysis of the 64 completed questionnaires showed improved confidence in working with children in at least one area of speech or language in 79%. Comments about the Collaborating for Communication project are listed.

The need for SOAP.

Armstrong L, Bain A. (2003)

When the authors found they were piloting the same off-the-shelf package they were naturally interested to compare methods and results. ‘Swallowing . . . on a plate’ (SOAP) may benefit people with dysphagia, but the principles are relevant to any client group where the aim is to train other professionals in basic assessment and management. SOAP contains four instruments: a prefeeding checklist, swallowing assessment checklist, swallowing management index, and a swallowing care plan. The studies were undertaken to evaluate the short and longer-term effects of training on residential and nursing home staff in terms of improved knowledge, changed working practices, and improved quality of care. One project was based on extensive training by one SLT, and whilst the other had a team approach, the number of staff trained was very different. The outcomes of the two approaches are compared and contrasted, and preferences discussed

When is good enough?

Gamberini L. (2003)

When does a speech and language therapist have ‘sufficient’ competency to manage a client whose difficulties fall outside the remit of standard training? This article explores this in relation to people with dysphagia associated with head and neck cancer and finds that, as a profession, we have much to ponder. Head and neck cancer patients often need to attend speech and language therapy for communication and swallowing difficulties resulting from their treatments at centralised units. Because of the distances involved, responsibility is often devolved to the local community therapist. Whilst postgraduate training is required for work with dysphagic adults, for the majority this will be at post-registration level, with few going on to advanced level. For work with head and neck cancer patients it is important that SLTs have knowledge of the staging of tumours, pre-operative counselling, tracheostomy tubes and their effect on swallowing, assessment and management of swallowing problems, multidisciplinary team working, radiotherapy and its effects, and body image. These areas are described and illustrated with a case report. The implications for standards of care and the content of dysphagia training are discussed.

How I augment AAC.

A case of need.

Davies C. (2003)

It took five years for Nottingham to get a specialist AAC post for adults. This article gives examples of the initiatives, successes and ongoing challenges of the first 18 months. Two user groups have been formed to share experience and develop resources. A major issue is the continuing difficulty in obtaining funding, particularly when different agencies are involved in paying for communication aids. The writer’s role within the speech and language therapy team for adults with learning disabilities is towards high tech equipment, and some of the qualities brought to this role are described.

Communication – by the book.

Millar S. (2003)

A communication book is a simple low tech aid to communication either on its own or as part of a range of communication methods. This article explains how different communication books are matched to different clients’ abilities to communicate independently and their involvement in communication. Points to consider are discussed under design and layout, vocabulary selection and organisation, and symbol books and language development.

Get out there and use it!

Scott J. (2003)

In the past, alternative and augmentative communication was perhaps seen as a rather exclusive field – but this is changing. A small number of service users will always need specialist input using high tech equipment and it is important that we have therapists who keep up with the breathtaking pace of improvements in the capacity and flexibility of technology. At the same time, however, we have greater awareness of the fundamental importance of all therapists developing an inclusive and enabling communication environment for everyone. Whether high tech, low tech or a combination of methods the three articles, of which this is the first, demonstrate why the implementation of AAC needs strategic thinking, practical skills and a strong focus on the needs of users. There are many things to think about when choosing a graphic symbol system. This article takes us through the decision-making process considering the construction, the level of symbolic representation and flexibility. Construction includes ease of reproduction, and the visual abilities of the client. The level of symbolic representation requires consideration of the appropriateness of graphic symbols, their transparency, or guessability of meaning. Flexibility includes vocabulary, and the importance of not neglecting grammar, whether support is available, and what other symbolic systems are in use.

My top resources.

Prevezer W. (2003)

The author is both a speech and language therapist and a musician, working as a music specialist at Sutherland House School in Nottingham for children with autism, and runs musical playtime sessions for babies and toddlers in her local community. She also gives courses and workshops on using music to facilitate social and communication skills. The resources she describes include the actual process of interaction, fabrics, a drum, ‘Rosanna Rib’ xylophone, an autoharp, game songs with Prof Dogg’s Troupe, a small dog, informed intuition, and video facilities.