Winter 2008

Articles from the Winter 2008 Issue


Getting off to a flying start

Esther Black

Collaborative working with early childhood educators in an environmentally deprived area

As a newly qualified ‘Flying Start’ speech and language therapist Esther Black was looking forward to collaborative working in an environmentally deprived area, but in the event found service delivery in nurseries frustrating. She joined a departmental working party convened to address this issue across Fife. Participants considered literature on effective training, a ‘best nursery ever’ activity and a domainal map to judge the feasibility of change. Esther describes how she worked with a senior colleague, a head teacher and an educational psychologist to take forward the working party findings in one nursery, and the impact this had on staff’s communication with the children. She also reflects on how her own skills and confidence have developed and outlines her plans for the future.


“It’s to have a laugh and be with others”

Charly Harvey

Getting – and acting on – feedback about therapy from clients with dementia

Accessing user views is an integral part of the way speech and language therapists in Medway work and, over the past decade, has informed changes in service delivery. Charly Harvey was keen to find a way of enabling people with dementia to express their views personally rather than through their carers. She took the opportunity of a 5 week cognitive stimulation group run jointly with a clinical psychologist to gather sessional and end of group feedback through supported conversation techniques. She also got the thoughts of the clients’ carers (wives) via a questionnaire. A psychology trainee rated clients’ communication skills throughout. Charly found the feedback gave more valuable pointers to future improvements than the health professionals’ own reflections.


Sitting on both sides of the fence

Kirstie Page

Practical tips for working with teachers from an educational consultant with dual training in speech and language therapy and teaching

Kirstie Page started out as a speech and language therapist. As she became increasingly aware of the impact of children’s speech and language skills on their learning – and of potential modifications in the educational environment which could help – she decided to train as a teacher. While her background in speech and language therapy was an asset, the level of preparation and organisation that is required of teachers was particularly demanding and the differences in the two professions were greater than she anticipated. Kirstie considers the pressures on each ‘side of the fence’ and practical ways that speech and language therapists can work more effectively with teachers. She is now using her dual training as a consultant with StoryPhones, a new digital audio system to promote literacy, language and literacy skills in the Foundation Stage and Key Stage 1. (See also ‘Critical friends’ feedback on this article here.)


Here’s one I made earlier

Alison Roberts brings a Christmas theme to these low cost, flexible therapy suggestions for a variety of client groups: ‘Save your cracker jokes’, ‘Interaction paper chains for Christmas’ and ‘Gift list’.


Dead good transitions

Nadine Arditti & Debbie Swift

Making the move from primary to secondary school easier for pupils with communication difficulties

The move from primary to secondary school can be a daunting prospect, particularly for pupils with communication difficulties. Nadine Arditti and Debbie Swift have been running a 3 day Year 6 transition group since 2003 for children with a range of communication support needs. The aim is to supplement preparation by primary schools with teaching of specific skills such as reading a timetable, new vocabulary, getting organised and making friends. Parents and educational welfare professionals are also involved. Nadine and Debbie present the results of an audit of the group over the past 3 years. They have now published a pack with photocopiable resources for organising a transition group. They have also been working with children as part of a multi-professional group to develop a booklet to support the transition process.


Ripples in a pond

Avril Nicoll

Celebrating the 10th birthday of the Picture Exchange Communication System (PECS) in the UK

The Picture Exchange Communication System (PECS) is a low-tech AAC tool designed to encourage initiation of communication. The defining feature of PECS is teaching spontaneous requesting as the first skill. It was developed in the 1980s in the United States by Lori Frost and Andrew Bondy, and was first used in the UK in 1998 where it is administered by Pyramid Educational Consultants. Pyramid is an approach to education which runs from wake up to bedtime and is heavily influenced by Applied Behaviour Analysis learning theory. Speech & Language Therapy in Practice editor Avril Nicoll reports on an event to celebrate 10 years of PECS in the UK. This included reflections from a parent of an 8 year old boy to whom PECS ‘pictures mean the world’ and recent thinking from Andrew Bondy on how we can help children with autism develop the language of emotions.


Are you getting enough (4) From supervisee to supervisor

Sam Simpson & Cathy Sparkes

In the last of our supervision series, the focus is on making a successful transition from supervisee to supervisor

Sam Simpson and Cathy Sparkes conclude their series on supervision by exploring how therapists gain the experience and skills needed to make the transition from supervisee to supervisor. While current practice seems to expect therapists to develop these skills by osmosis, the authors argue a more structured approach is needed. Focus groups convened especially for the series identify key skills and qualities which those making the transition can develop through training and supervision. The authors suggest how the profession could do more to support the supervision process and offer two practical activities.


How I use electropalatography (1): Moving forward with EPG

Ann Nordberg, Elvira Berg, Goran Carlsson & Anette Lohmander

How EPG helped two boys with severe motor speech disorders due to cerebral palsy

Ann Nordberg and colleagues present case examples of Bjorn (10) and Gabriel (7), both of whom have severe motor speech disorders due to dyskinetic cerebral palsy. In spite of receiving a lot of speech and language therapy using traditional techniques they had not made significant improvement. Having reviewed literature on the real-time visual feedback device Electropalatography (EPG), the authors embarked on a clinical study. By the end both boys had learnt where to place their tongues and had changes in EPG patterns which demonstrated a more stable anterior place of articulation. There was also a secondary diagnostic benefit for Bjorn. In future studies the authors wish to explore whether EPG can improve intelligibility in a social context.


How I use electropalatography (2): Therapy on a plate

Lesley Anne Smith

Small but important gains of EPG for young man with chronic articulatory dyspraxia following a stroke

Lesley Anne Smith says that chronic articulatory dyspraxia following head injury is notoriously difficult to remediate, and traditional methods are limited once the client reaches a plateau. She used the visual biofeedback system Electropalatography (EPG) with a client who had a stroke at the age of 33, leaving him with physical, cognitive and communication impairments. Support was offered by a specialist colleague in the paediatric service and Lesley’s department funded the palatal plate. The department offered as much time as they could afford from a speech and language therapist and a technical instructor to make maximum impact. Therapy and progress is described. Lesley concludes that for a person whose intelligibility is severely reduced and who cannot make use of AAC, EPG could be worth pursuing even for small gains.


My top resources – children’s centres

Waltham Forest Children’s Centre Team

The essential people, tools and approaches for speech and language therapists in a children’s centre

Speech and language therapists in the Waltham Forest Children’s Centre Team list the people, approaches and tools that are most important to their work, including parents, key word signing and bubbles.


The third person in the room

Avril Nicoll

Symposium reflects on wide applications of low tech communication framework Talking Mats

Talking Mats is a low tech communication framework designed to help people with communication difficulties express their views. Speech & Language Therapist Joan Murphy developed the idea in 1998 and now a team of researchers, therapists and other professionals is involved in rolling it out across the world. Speech & Language Therapy in Practice editor Avril Nicoll reports on a Symposium held to celebrate the first 10 years of Talking Mats. Talking Mats can be used with a variety of client groups (including people with learning disabilities, aphasia or dementia and children with special needs) for purposes including getting to know someone, reflecting, setting goals, establishing consent, making decisions and comparing views over time. Participants explained why Talking Mats may be particularly helpful where sensitive or difficult issues such as sexual abuse are involved. Two careers guidance officers use Talking Mats with people who do not have communication difficulties and find it introduces a helpful ‘third person in the room’ element.