Speech & Language Therapy in Practice, Autumn 2000

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AUTUMN 2000

GroupsAdapting theenvironment

Sensory

integrationGetting in synch

HomeprogrammesReducing risk

In My ExperienceValuing voice

ISSN 1368-2105

R E F L E C T I V E L E A R N I N G

http://www.speechmag.com

Student traininga uniquepartnership

How I manageearly feeding difficulties

My Top ResourcesIn the community

Two greatreader offers

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http://www.speechmag.com

In 1999, Professor Sally Byng spoke to

speech and language therapists from all

over Scotland about her vision of aphasia

services. A year on she was back with

Carole Pound to hear first-hand the

changes that have been made.Annette

Cameron reports.

SIGNALONG researcher Kay Meinertzhagen

recently spoke to a group of learning

disabled adults as part of a project to

establish signing vocabulary for self-

advocacy. What they told her has

implications for the project and for service

providers generally.

The Autumn2000 speechmag web-

site includes:

www.speechmag.com

Also on the site - contents of back issues and news about the next one, links to other sites ofpractical value and information about writing for the magazine. Pay us a visit soon.

Now available: subscribe or renew online!

Reprinted articles

Student teachers recognise their voice needs (Roz

Comins, 2 (4), August 1993)**

At last...stammerers get the right prescription from

their GPs (Lena Rustin and Elaine Kelman, 4 (1),

Nov/Dec 1994)**

A service resource - New ventures in group

placements for students. Part 2 - Group placements

with adults with a learning disability (Ann Parker

and Rachel Farazmand, Winter 1997)***

From Speech Therapy in Practice* / Human Communication**,courtesy of Hexagon Publishing, or from Speech & LanguageTherapy in Practice***

tel: 01561 377415 www.speechmag.com

reflective. creative. hardworking.original. energetic. friendly.approachable. thoughtful.interesting. realistic. up-to-date.reliable. the magazine thats you.


3/32SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 1

20 Home programmes...when parents understand more fully the nature of

their childs stammering and their role in its

remediation, they are often very resourceful inmaking arrangements so they can attend therapy.

However, for a minority, there may be reasons...which

mean regular attendance is impossible.

Sharon Millard, Frances Cook and Jane Fry

explain how a new approach is benefiting children at

risk of persistent stammering who are unable to

attend a clinic for therapy.

24 Further ReadingEarly intervention, hearing impairment,

dysarthria, AAC, dementia.

25 How I manageearly feedingdifficultiesFeeding management should always be

seen as multidisciplinary. This is sometimes

difficult to put into practice in community

caseloads but, the more we consult our

colleagues such as dietitians and

psychologists for advice, the more we gain

professionally - as do they.

There are many questions about the speech

and language therapists role with early

feeding difficulties. Sue Strudwick,

Joanne Marks and Sara Russell provide some ofthe answers.

30 My Top ResourcesRecent groups have been either language disability-

focused or project-based;

for example people with

aphasia produced a leaflet

for others with aphasia.

For the near future we are

hoping the service will be

able to replicate a model

of effective group

intervention via

conversational analysis.

Linda Armstrong and

Alison Parsons have to

adapt their working practice

to take account of the

geographical spread of their

clients - adults with acquired

neurological problems.

SUMMER 2000(publication date 28th August)

ISSN 1368-2105

Published by:Avril Nicoll33 Kinnear SquareLaurencekirkAB30 1ULTel/fax 01561 377415e-mail:[email protected]

Production:Fiona ReidFiona Reid DesignStraitbraes FarmSt. CyrusMontrose

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Editor:Avril Nicoll RegMRCSLT

Subscriptions and advertising:Tel / fax 01561 377415

Avril Nicoll 2000Contents of Speech & LanguageTherapy in Practice reflect the viewsof the individual authors and notnecessarily the views of the publish-er. Publication of advertisements isnot an endorsement of the adver-tiser or product or service offered.

Any contributions may also appearon the magazines Internet site.

2 News / Comment

4 GroupsAs therapists, we were reminded how little wenormally adapt our usual working practice, as we are

often unaware that our clients have particular

sensory impairments... We found small changes made

a big difference when enabling clients to achieve

success.

Christine Griffiths and Alison Gedling investigate

the efficacy of speech and language therapy for

people with learning disability and sensory

impairment attending a Day

Centre.

8 Sensory

integrationSpeech and language therapy

assessment and intervention

techniques with, for example,

children with speech disorders,

have the potential to be

informed and transformed by

sensory integrative theory and

practice.

Olwen Pate reveals how

getting suck, swallow, breathe

in synch can facilitate progress

in oral motor skills and speech.

11 Reader OffersWin CELF and Speech Sounds on Cue

12 ReviewsAdult neurology, syndromes,

dysfluency, progressive

neurological, language

development, education,

articulation, autistic spectrum,

child development.

18 In my

experienceThe cry of a teacher in vocal

distress should not fall upon deaf

ears; rather we should seek to

ensure it is never raised at all.

Caroline Cornish on the case for

a national policy of preventative

voice care for student teachers.

ContentsAUTUMN 2000

Cover picture:See page 14, Competence, confidenceand commitment.Photo from: www.johnbirdsall.co.uk

www.speechmag.com

IN FUTURE ISSUES

FRAGILE X PROGRESSIVE NEUROLOGICAL DISORDERS DOWN SYNDROME

PHONOLOGICAL AWARENESS DYSPHAGIA TRAINING

TrainingWe have been moving towards

emphasising reflective cycles of learning

which integrate practice, theory and

rehearsal, rather than the traditional

linear model with its expectation thattheory and observation should always

precede practice.

Suzanne Beeke and Ann Parker are

behind an innovative programme

where speech and language therapy

students become temporary volunteers

for the Stroke Association.

14 COVER STORY

Please note our new address!


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Inclusion and autism

SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 20002

news

People with aphasia

are being encouraged

to demand an ade-

quate service.

Members of the

charity Speakability

have developed a

Charter for People

with Aphasia

based on their

own experiences

and reflecting

clinical guide-lines endorsed

by the

Department

of Health. It

includes a list

of speech

and lan-

guage ther-

apy rights.

A recent

survey by

Speakability draws attention

to the paucity of aphasia services and the drain

dysphagia care places on resources.

Helpline Freephone 080 8808 9572 Mon-Fri 10am-4pm

Speakability, tel. 020 7261 9572.

A new report slams the quantity, organisation and targeting of care and treatment

for people with disabilities.

As a result of the reports findings, the Royal College of Physicians has produced a

set of recommendations for commissioners of healthcare, NHS managers, medical

educators and doctors aimed at redressing the balance towards the needs of dis-

abled people. Specifically, they want to see the specialty of rehabilitation medicine

developed, adequate staffing levels and a change in medical attitudes so doctors pro-

mote disabled peoples abilities and empower them to participate in society.

However, a British Society of Rehabilitation Medicine survey of NHS resources sug-

gests there is a long way to go to meet the recommendations. The tenfold or greater

differences in access of disabled people to NHS consultants in rehabilitation theyidentify lends support to the theory of rationing by postcode, and they call for

inequities to be addressed urgently.

Medical rehabilitation for people with physical and complex disabilities, RCP,

www.rcplondon.ac.uk

BSRM, tel. 01992 638865.

The charity Scope has welcomed an Audit Commission report highlighting waste and

failure within NHS disability services, and urged an immediate crackdown.

However, Scope says the government should have introduced national standards

years ago and is disappointed that the report still fails to emphasise the need for NHS

providers to listen to disabled people. Its campaigns officer says, If the providers of

such services had a duty to take on board the views of equipment users, there would

be far less waste and inefficiency. For disabled people to achieve equality and inte-

grate into mainstream society, the government has to ensure that the right equip-

ment gets to the right people right now.

Fully Equipped (28/3/00) from the Audit Commission.

Scope, tel. 020 7619 7100, www.scope.org.uk

Children with autism and Asperger

Syndrome are on average twenty

times more likely to be excluded

from school than their peers.

According to a report commissioned

by the National Autistic Society, the

situation is even worse for more ablechildren with autism, of whom 29 per

cent have been excluded from school

at one time or another. The Society is

calling for urgent action to address

the lack of expertise, time and spe-

cialist help thought to lie at the root

of the problem. Its education adviser

points out that Parents of children

in autism-specific units and schools -

where exclusions rarely arise - are

twice as likely to be satisfied with

provision than those whose children

attend mainstream or special educa-

tion needs schools.

The report also finds there is less

awareness by the time a child reach-

es secondary age and that exclusioncontinues into adulthood. Although

many adults cited a job as one of the

most important issues for their

future fulfilment, only two per cent

of adults with autism, including

graduates, are in full-time paid work.

Inclusion and Autism: Is it Working?

From the National Autistic Society,

393 City Road, London EC1V 1NG,

www.oneworld.org/autism_uk

Disability servicesslammed

Dementia visionPeople around the country are being asked for their views and experiences

of services and their vision of dementia care.

Alzheimer Scotland - Action on Dementia is working on a major project to

create a Scottish Dementia Care Services Template. At its core will be targets

for the range and volume of services which should be available to people

with dementia and their carers from the start of the illness to the final stages.

Essential services listed include memory clinics and rehabilitation / therapies.

Contact: Public Policy Department, Alzheimer Scotland - Action onDementia, 22 Drumsheugh Gardens, Edinburgh EH3 7RN.

Dementia Helpine (Scotland), freephone 0808 808 3000.

Partnership between carers, people with dementia and the research community

is also the aim of the Alzheimers Society which is recruiting people

for an advisory network to inform its research programme,

Quality Research in Dementia. Focusing on cause, cure and

care projects, 1 million per year has been com-

mitted, the largest investment by any

charity into dementia-related research.

Alzheimers Helpline: 0834 300 0336.

S.M.A.R.T. movesAn assessment to prevent misdiagnosis of vegetative state in patients with pro-

found brain injury will be available to rehabilitation units by the end of the year.

The Sensory Modality Assessment and Rehabilitation Technique (S.M.A.R.T.)

has been developed over a ten year period by occupational therapy staff at

the Royal Hospital for Neuro-disability. The hospitals brain injury unit treats

the largest concentration of patients in a vegetative state in the UK. Using

S.M.A.R.T., one study of patients admitted with a referring diagnosis of veg-

etative state found 43 per cent had been wrongly diagnosed. Such misdiag-

nosis can lead to a patient with the potential ability to communicate their

needs - such as someone with locked-in syndrome - spending the rest of their

life trapped in a damaged body. Vegetative state is the most profound form

of brain damage where the person is awake but completely unaware of

what is happening around them or within their own body.

The assessment provides a structured sensory programme which assesses the

five senses, movement, communication and wakefulness. The multidiscipli-

nary team and the patients relatives and friends are a key part of this

process.

www.neuro-disability.org.uk

Aphasiacharter


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National screeningA programme to screen for deafness in new-born

babies is to be phased in from September this year

before being rolled out nationally.

The Royal National Institute for Deaf People has wel-

comed this development, saying The test can be

carried out within 48 hours of birth and does not dis-

turb the baby. It involves an instrument sending a

sound into the babys ear and measuring the level ofreturned sound which calculates the level of hearing

function. The test is proven to be cost effective and

reliable. The organisation believes a comprehen-

sive national screening programme will enable earli-

er provision of aids, introduction to sign language

and development of communication. Health visitor

distraction tests used currently have a poor record in

identifying children who are born deaf.

RNID, tel. 020 7296 8000, www.rnid.org.uk

SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 3

news & comment

Jane Austen knewIn a scene in Pride and Prejudice, Elizabeth Bennet observes that Mr Darcy

must comprehend a great deal in his idea of accomplished if he knows only

six such women. He and Caroline Bingley list the numerous qualities and skills

they consider necessary and Lizzy is forced to conclude I am no longer

surprised at your knowing onlysix accomplished women. I rather wonder

now at your knowing any.

What makes an accomplished speech and language therapist? A number ofclues come from Sue Strudwick. A therapist must be knowledgeable,

competent, empathetic, enthusiastic, honest and realistic, as this builds a

client or carers trust and confidence and contains their anxieties. How I

manage early feeding difficulties demonstrates this is enhanced when our

goals are patient-led, when we work with other professionals as a team and

when the organisation of our posts allows us to cross boundaries to provide

the consistency clients need.

Like teachers, our voice is the tool of our trade, but do we appreciate the

potential we all have to improve it? Caroline Cornish believes we should be

committed to development of the voice to make it the source of real

inspiration to others.

Initiative and flexibility are needed to carry out speech and language therapy

in challenging environments. For Linda Armstrong andAlison Parsons this

means some rather unusual top resources, as they work in a large rural area

where their adult clients are spread out and not easy to reach.

We need to remember to apply what we know. Christine Griffiths andAlison

Gedling refer back to their own guidelines as a reminder of small

environmental changes that can make all the difference to a client with

learning disability and sensory impairment.

We have to be responsive. Sharon Millard, Frances CookandJane Fry

understand that attendance at a clinic is not always possible and use other

methods - such as telephone contact - to ensure timely therapy can still be

provided to those who are motivated.

However, as Olwen Pate has found, the key to success is in the integration of

skills, and the challenge for us is how to facilitate this not only in our clients

but in ourselves. Suzanne Beeke andAnn Parkergive us an example with

their innovative programme of student training based on reflective cycles of

learning which integrate practice, theory and rehearsal through active

participation.

As Jane Austen knew, we can pick out individual qualities and skills that are

important - but that wont tell you what distinguishes the Elizabeth Bennet

from the Caroline Bingley.

...comment...

Avril Nicoll,

Editor

33 Kinnear Square

Laurencekirk

AB30 1UL

tel/ansa/fax 01561

377415

e-mail

[email protected]

Online consultationA website is providing a groundbreaking method of

responding to a public consultation exercise.

Visitors to the Disability Rights Commission site can

respond online to a joint consultation with the

Department for Education and Employment on a

new draft Code of Practice for making goods and ser-

vices more accessible to disabled people. The draft

Code is posted on the website, along with a responsedocument which can be filled in and returned online.

The site meets high standards for accessibility and has

approval from the Royal National Institute for the Blind.

DRC, tel. 020 7211 3000, www.drc-gb.org

Education trainingThe national educational charity for children with

speech and language difficulties has extended and

developed the training it offers.

In addition to extra courses focusing on integrating

speech and language targets and approaches into the

classroom and curriculum, a series of seminars present-

ed by internationally regarded experts will provide an

up-to-date review of a range of topics. If distance is a

problem, workplace training encourages authorities to

purchase I CANs multidisciplinary training at a local

venue - significantly reducing the cost per person.

Details: Jaszia Lindon, Training Administrator, 0870

010 7088.

New chiefs plansThe new chief executive of the charity which helps

families who care for children with a disability orspecial need brings extensive experience in the par-

liamentary and public affairs field to her role.

Francine Bates plans include the expansion of advice

and information services to parents and professionals.

She is also particularly looking forward to the imple-

mentation of legislation which brings forward new

entitlements for carers of disabled children in the field

of social care and special needs education. On the

health front, we are working closely with NHS Direct

Online and will be launching our new directory of spe-

cific conditions and rare syndromes in January 2001.

Contact a Family, tel. 020 7383 3555,

www.cafamily.org.uk


6/32

groups


e have been carrying out a

research project looking at

the efficacy of speech and

language therapy with peo-

ple with learning disability

and sensory impairment

(Griffiths and Gedling, 1999). Research suggests

the incidence of visual and hearing problems in

people with learning disability is high, particularly

those with Downs syndrome (Yeates, 1989; Kwok

et al, 1996; van Schrojenstein Lantman-de Valk et

al, 1994). A large study of 45,000 adults indicates

a prevalence of sensory impairment among adults

with intellectual disability comparable to orgreater than that found in the general population

and that these sensory deficits occur with increas-

ing frequency with advancing age (Janicki and

Dalton, 1998). Research also indicates that carers

are not reliable in identifying these deficits (Haire

et al, 1991) and that there is a need to heighten

awareness among staff and other carers with

regard to vision and hearing problems and the

consequent problems which may develop in inter-

personal communication and adaptive function-

ing. Aitken and Buultjens (1992) also point out

the effects on communication, including pragmat-

ics and non-verbal communication, and many

studies further recognise the changes in behav-

iour that can occur (Stafron, 1995; Castane and

Peris, 1993).

Part of our work is with people with learning

disability who attend a Day Centre. We felt the

focus of our intervention should be social com-

munication skills and targeted three common

areas we deemed feasible to work on with people

with a wide range of learning disability:

1. eye contact

2. initiation

3. turn-taking.

In our planning we considered the above research

findings: the high incidence of hearing / visual

difficulties, the effects of ageing, the need to

raise staff awareness, and the effects of sensory

W

A (sight and)sound

foundation

We may be aware of the

effects of visual and

hearing impairments on

communication, but how

often do we routinely allow

for them when planning

therapy? Christine Griffiths

andAlison Gedling tell us

how small changes made a

big difference to their clients

with a learning disability.

Read this if you:

work with any client with

sensory impairment

offer staff training

want social skills therapy

ideas

impairment on communication and behaviour.

All the clients had their vision and hearing

assessed at the Day Centre prior to communication

assessment and intervention. Results, including a

breakdown of degree of impairment, are in tables

1-3 (page 6). This information was then taken into

consideration when carrying out the intervention

programme, particularly in terms of positioning,

size of materials and environmental factors.

Guidelines were also written for staff (figure 1).

Small stepsClients were assessed using the Background infor-

mation and Social Communication skills sectionsof the Personal Communication Plan for People

with Learning Disability (PCP) (Hitchings and

Spence, 1991). We felt, however, that any poten-

tial progress in the people with more severe/pro-

found learning disability may not be identified

from the PCP rating scale, as it is not broken down

into small enough steps. We therefore decided to

include video of client/carer interactions. These

were then analysed by:

Using observation checklists and momentary

sampling to identify the individuals levels of

engagement (Bunning, 1991).

Identifying particular aspects within each level of

engagement, such as awareness, initiation and rec-

iprocation. These could then be matched against

appropriate sections of the PCP - eye contact, open-

ing a conversation (initiation) and turn-taking.

The focus of intervention was the same for all

the clients who received treatment: eye contact,

initiation and turn-taking. However, we felt it

was appropriate to develop two programmes to

respond to the cognitive level of those involved.

In practice we found that, whilst one distinct pro-

gramme was better for one person, another

might benefit from a mixture of the two, and so

the programmes were meant to be flexible in this

respect. The intervention was offered as a regular

weekly session over a ten-week period (figures 2

and 3).



groups

Figure 1 - CommunicationGuidelines

8 rules when speaking topeople who have visionand / or hearing loss

1. Make sure you have thepersons attention first.

2. Make sure thatdistractions are kept to aminimum.

3. Prepare the environment.

4. Make sure there isappropriate lighting.

5. Look directly at thelistener and dont turnaway while talking.

6. Make sure that your faceand mouth are not hidden.

7. Value the persons

communication.

8. Adapt yourcommunication to enablethe person tocommunicate better.

Figure 2 Treatment plan (Profound group)

Each week - develop a routine. Begin the session with an object of reference (for example a bean bag) and music.Finish with music and put all items away together.

Weeks 1 to 3 - eye-contact

The aim of these three weeks was to attract the clients attention and maintain it. Activities included the use of avariety of glittery objects and a torch (or auditory objects), the task increasing in complexity as follows:1) Say the clients name.

2) Hold the object in front of their line of vision. Use a torch to refract the light.3) When they have focused on it, move it towards your eyes.4) When achieved say Hello.The session finished by building a tower of blocks. The client was encouraged to look at each block (held near thespeech and language therapists face).

Weeks 4 to 6 - turn-taking

These sessions encouraged the client first to copy actions and then to take turns in a variety of activities; for exam-ple taking an object out of a feely bag and doing an action with it, using peg-boards, jigsaws, colouring paper sil-houettes on black card, using bubbles.The session finished by taking turns to build the tower of blocks.

Weeks 7 to 9 - initiation

These sessions encouraged the client to make a choice between three musical instruments and imitate an action.The instruments were then put out of reach, the client having to use physical contact - such as a tap on the arm orvocalisation - to be given one of them. This was initially facilitated. Other activities included selectingcrayons/chalks, different coloured paper for contrasts and chalkboards.The session finished by encouraging the client to use eye contact, vocalisation, reaching or tapping our arm toattract our attention to get a block for building the tower.

Week 10 - eye-contact, turn-taking and initiation

Clients were encouraged to participate in cake decorating using a variety of toppings and icing pens.

Figure 3 Treatment Plan (Mild/moderate/severe group)

Weeks 1 to 3 - eye contact

Activities included:1) Ball games and signing/saying each others names, what you like to eat, and so on.2) Dressing-up items - hats, glasses, red noses, masks. Look in the mirror and at eachother.3) Describe yourself. (Talkabout)4) Happy/sad masks - choose the mask that is the same as me.

5) Describe family members - colour of hair etc.6) Make up faces with Magnetic Way To Language (now Magnetic Storyboard)7) Cut out eyes, ears, noses etc. from various materials and make up faces on paperplates.8) Eye pointing to particular pictures.

Weeks 4 to 6 - turn-taking

Activities included:1) Copy rhythms on a tambourine or drum.2) Select an item from a feely bag and do an action with it. Copy each other.3) Take turns to trace around place setting shapes and colour them in.4) Take turns with jigsaws, peg-board patterns etc.5) Whats my mime?game - guess the animal being mimed.6) Pelmanism.

Weeks 7 to 9 - initiation

Activities included:1) Using greetings and responses.2) Choice of musical instrument - client encouraged to initiate the rhythm for us tocopy.3) Feely bag - initiate action with item pulled out.4) Client to finish the last bit of a task; for example, the last piece of jigsaw, place set-ting (no fork), drum and stick. Attract our attention to do this.5) Model food - select what you like to eat.6) Decorating a Christmas tree.7) Making paper chains.8) Making gift tags.

Week 10 - eye-contact, turn-taking and initiation

The final week encouraged the client to use eye contact, take turns and initiate con-tact whilst participating in cake decorating. A selection of toppings and icing penswere available and fairy cakes.

Figure 4 Environmental programme for staff

Week Staff programme

1 gaining attention

2 attention and positions

3 contrasts and zones

4 reduce distractions

5 carer communication



8 environmental

9 environmental

10 task for staff to evaluate theeffectiveness of guidelines given

In our planning we considered the high

incidence of hearing / visual difficulties,

the effects of ageing, the need to raise

staff awareness, and the effects of

sensory impairment on communication

and behaviour.


8/32

Staff were also given information every week

advising them of various environmental aspects

that should be considered (figure 4) and sugges-

tions for activities were given. All information

was recorded in an exercise book, which was also

available for staff to note their own comments

along with a pictorial reminder of the guidelines.

FlexibilityWe found this approach very useful when work-

ing with adults with a wide range of learning dis-

abilities and additional sensory impairments. Two

programmes which focused on the same areas of

intervention allowed us the flexibility to adapt

the sessions to the appropriate cognitive ability of

the client. They also gave us a solid structure on

which to build the additional requirements neces-

sary for the particular sensory impairment of that

client. Staff also found it much easier to focus on

themes.

As therapists, we were reminded how little we

normally adapt our usual working practice, as we

are often unaware that our clients have particular

sensory impairments. We may automatically try

to reduce noise levels, too much visual stimulation

on the walls and so on, and position for optimum

communication. However, we rarely routinely

groups


consider the effects of glare, contrasts between

our visual material and the table or the effects of

open windows and doors - even though we are

aware of them. It was therefore certainly benefi-

cial to us to look through our own guidelines and

consider these whilst preparing the equipment

beforehand. We found small changes made a big

difference when enabling clients to achieve suc-

cess.

As with any course of intervention ours was not

without problems, which generally were con-

cerned with factors we couldnt change such as

absence of clients and staff, clients health, and

attendance at respite care. We also experienced

some difficulty in disseminating information

amongst staff, which obviously affected the conti-

nuity of care to our clients.

This approach required some forethought, par-

ticularly from staff, and therefore could have

been seen as time-consuming. Whilst there

remain many aspects that will require encourage-

ment to be routinely carried out, changes were

made where possible. There was definitely

heightened awareness regarding the sensory

needs of individual clients amongst staff and

nearly all the clients receiving intervention made

progress. This has given us a sound foundation on

which to build further work on social communica-

tion skills with our clients in Day Centres.

Christine Griffiths is Deputy manager and Alison

Gedling a speech and language therapist for the

Learning Disabilities Directorate, Bro Morgannwg

NHS Trust.

AcknowledgementsOur thanks go to Maggie Woodhouse, Senior Lec-

turer of Optometry and Jonathan Joseph,

Principal Audiologist who carried out the sensoryassessments at the relevant Day Centres and

therefore made this study possible.

ReferencesAitken, S. & Buultjens, H. (1992) Vision for Doing:

Assessing Functional Vision of Learners who are

Multiply Disabled. Moray House Publications,

Edinburgh.

Bunning, K. (1991) Individualised Sensory

Environments: Assessment and Intervention.

Unpublished.

Castane, M. & Peris, E. (1993) Visual problems in

people with severe mental handicap. Journal of

Intellectual Disability Research 37(Pt 5): 469-78.

This approach

required some

forethought,

particularly from

staff

Table 1 Level of learning disability; clients level of vision

Clients level of vision

normal mild normal moderate severe profound uncooperative Totalwith ownglasses

Learning mild 3 1 2 0 0 0 0 6

disability moderate 19 37 11 15 5 0 0 87

severe 4 16 0 10 7 1 11 49

profound 0 3 0 2 1 3 4 13

Total 26 57 13 27 13 4 15 155

Table 3 Clients level of hearing; clients level of vision

Clients level of vision

normal mild normal moderate severe profound uncooperative Totalwith ownglasses

normal 20 40 10 11 8 2 2 93

Clients mild 1 5 0 2 2 0 2 12

level of moderate 2 11 1 7 2 1 4 28

hearing severe 1 0 0 0 0 0 0 1

profound 0 0 1 1 0 0 0 2

uncooperative 0 1 0 5 1 1 7 15

Total 24 57 12 26 13 4 15 151

Table 2 Level of learning disability; clients level of hearing

Clients level of hearing

normal mild moderate severe profound uncooperative Total

Learning mild 5 0 1 0 0 0 6

disability moderate 66 7 11 1 1 1 87

severe 24 5 14 0 1 7 51

profound 2 0 5 0 0 7 14

Total 97 12 31 1 2 15 158


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Griffiths, C. & Gedling, A. (1999) A longitudinal

study to evaluate the efficacy of Speech and

Language Therapy interventions on social com-

munication skills in those individuals with sensory

impairment and learning disabilities.

Unpublished.Haire, A. P., Vernon, S. A. & Rubinstein, M. P.

(1991) Levels of visual impairment in a day centre

for people with a mental handicap. Journal of

the Royal Society of Medicine 84 (9): 542-4.

Hitchings, A. & Spence, R. (1991) The Personal

Communication Plan for People with a Learning

Disability. NFER-Nelson, Windsor.

Janicki, M. P. & Dalton, A. J. (1998) Sensory impair-

ments among older adults with intellectual dis-

ability. Journal of Intellectual and Developmental

Disability23 (1) 3-11.

Kwok, S. K., Ho, P. C., Chan, A. K., Gandhi, S. R. &

Lam, D. S. (1996) Ocular defects in children and

a d o l e s c e n t s

with severe

mental defi-

ciency. Journal

of Intellectual

D i s a b i l i t y

Research 40 (pt

4) 330-5.

Stafron, J.

( 1 9 9 5 )

Unpubl i shed

excerpts from

study day into

dual sensory

impairment -

SENSE.v a n

Schrojenstein

L a n t m a n - d e

Valk, H. M.,

Haveman, M.

J., Maaskant,

M. A., Kessels,

A. G., Urlings,

H. F. &

Sturmans, F.

(1994) The

need for

assessment of

sensory func-

tioning in age-

ing people

with mental

h a n d i c a p .

Journal of

Intellectual Disability Research 38 (pt 3): 289-98.

Yeates, S. (1989) Hearing in people with mental

handicaps: a review of 100 adults. British Institute

of Mental Handicap 17 (March).

ResourcesMagnetic Storyboardfrom Winslow, 59.95.

Talkaboutby Alex Kelly from Winslow, 32.00.

Whats my mime?LDA (discontinued).


groups

eflections

Do I find out the

extent of a

clients sensory

mpairments and

adapt therapy

accordingly?

Do I consider

how to measure

or smallchanges which

would not be

dentified by

tandardised

assessments?

Do I differentiate

he same task

when planning

herapy to allow

or the different

abilities of group

members?

...RESOURCES...RESOURCES...RESOURCES...RESOURCES.

Everyday Lives, EverydayChoicesThe ways in which the choices of people withsevere learning disabilities can be understood andimplemented are explored in a new book.Themes include communication, work, citizenadvocacy and staff development and training. Itmakes recommendations for government, localand health authorities, service providers and staffresponsible for individual assessment.Everyday Lives, Everyday Choices, 22.50 + p&p,from The Foundation forPeople with LearningDisabilities, tel. 0207535 7441/7455.

Hearing aid choiceA free, independent information pack explains thepotential pitfalls of choosing a hearing aid andgives information on the full range of options.Developed by a national charity with the supportof top hearing aid specialists, the guide is aimed atensuring people make an informed choice andavoid a costly or disappointing mistake.From Defeating Deafness, tel. 020 7833 1733.

MND Resource FileA comprehensive patient and carer-centredguide has been produced to support profes-sionals in achieving quality of life for peoplewith motor neurone disease.Areas covered include nutrition and dyspha-

gia, speech and communication and pallia-tive care. The guide aims to facilitate multi-disciplinary working and provide practicalhelp to professionals facing the challenge ofthe rapid progression of this disease and thecomplex needs of sufferers.Motor neurone disease kills three peopleevery day in the UK. Average life expectancyfrom diagnosis to death is just 14 months.MND Resource File 10 + 2 p+p, tel. 01604

250505, e-mail [email protected] MND Association Helpline, Mon-Fri, 9am-10.30pm, 08457 626262.

Turn your backThe forthcoming European Week for Safety andHealth is themed Turn your back on back pain.An accompanying pack includes posters, stickers,fact sheets, a range of booklets and ideas foraction. Musculoskeletal disorders and back painare the biggest single cause of absence from work.16-22 October, 2000 InfoLine: tel. 08701 545500

Our Mum has ParkinsonsA former schoolteacher has written a book explain-ing Parkinsons to children.Karen Goodall (40) was diagnosed with Parkinsonseight years ago and saw a real need to help otheryounger sufferers in this way. She says, I want chil-dren whose parents have the condition to know thatthere is help available and theres no need to be con-fused, embarrassed or shocked by Parkinsons.One in twenty people with Parkinsons are under

40 at the time of diagnosis.Our Mum has Parkinsons, 1 inc.p&p, tel. 01473212115. Parkinsons Disease Society, tel. 020 7931 8080.

Money Talks!A new educational soft-ware pack provides foursimulations for childrento practise money skills.The activities cover cost

of items on a till, shop-ping and selling, payingbills and money in asafe. Text is also spoken.Money Talks! on CDROM is suitable for 7 - 15 year olds. A single user

pack is 35 + VAT.From Topologika, tel. 01326 377771, www.topol-gka.demon.co.uk

Stroke AssociationThe Stroke Association has revised Learningto Speak Again and replaced it with a 12page booklet, Communication problemsafter stroke. It provides explanation of thecommon difficulties, assessment and treat-ment, and includes practical suggestions.Tel. 01604 623933/4/5/7/8.Stroke Awareness Week, 1-7 October 2000,will focus on the importance of continuingwith medication to lower blood pressure. Aninformation pack is available.Tel. 020 7566 0319 / e-mail Sue Knight on

[email protected]

InspirationA CD ROM to developideas and organisethinking is now avail-able in a UK version.This visual learning soft-ware tool includes facili-ties to create and modi-fy concept maps andwebs and to prioritise and arrange ideas.

A 30 day trial of Inspiration can be down-loaded from www.tagdev.co.uk

Seaside SignalongTwo resources from Signalong aim to help

with planning and enjoying a trip to the sea-side. A manual of 233 signs is accompaniedby an activity pack to help organise the dayand enable people in your care to learn fromtheir experiences.Signalong by the Sea and Activity Pack - tel.Signalong, 01634 819915.

Jobs on the netThe growing market of web-based servicesfor employers and job-seekers includes a sitededicated to health jobs. Templates allowemployers to post vacancies online and appli-cations can also be forwarded in this way.www.healthjobcentre.co.uk


10/32

sensory integration


pproaches to assessing and man-aging oral and speech motor

deficits in children usually include

tasks to evaluate and practise iso-

lated and sequenced oral and

speech motor movements. Such

end-product assessment of motor function sup-

ports the view that oral and speech motor deficits

are evidence of a peripheral motor output diffi-

culty. Intervention that follows this assessment

approach is likely to aim to develop specific out-

put skills to a given level, for example, the ability

to lick lips all the way round, or increasing the

speed and accuracy of /t/ production in isolation.

These techniques, while providing information on

deficits at a motor output level, do not identify

deficits that may be present at an earlier sensory

input level. Sensory input deficits may also cause

and / or contribute to oral and speech motor

deficits.

Sensory integrative theory (from the

Occupational Therapy field) emphasises sensory

inputs/deficits when assessing and developing

motor function. Motor planning and coordina-

tion difficulties are considered to be manifesta-

tions (end-products) of interference in the organ-

isation and processing of tactile, proprioceptive

and vestibular sensations. In sensory integrative

theory, then, an end-product behaviour, such as

developmental dyspraxia, is indicative of underly-

Read this if you work with any client with

a speech disorder find oral motor work

ineffective for improvingspeech

want to learn more aboutsensory integration

Aing sensory difficulties and a sensory integrativedisorder (Ayres, 1979). Sensory integrative theory

and research provides the evidence for practice

using sensory integrative approaches with clients

with sensorimotor difficul-

ties. Speech and language

therapy assessment and

intervention techniques

with, for example, children

with speech disorders,

have the potential to be

informed and transformed

by sensory integrative the-

ory and practice.

Since the control of artic-

ulatory movements for

speech demands the coor-

dination and integration

of multiple structures

(Smith et al, 1995), it is fundamental that assess-

ment and intervention reflect and treat these

structures and their function. The level and

nature of breakdown in planning, coordinating

and integrating oral, pharyngeal, laryngeal and

respiratory function is not likely to be clear when

isolated oral motor skills are assessed. That is,

when we ask a child to touch their nose with their

tongue, we are simply identifying the presence,

absence and, at times, the quality of a particular

movement. It is unclear as to how this movement

When faced with a speech disordered client, therapists often

recommend oral motor activities. While these may produce specific

splinter skills, any generalised benefit - particularly for speech - is

dubious. Olwen Pate explains how an approach using sensory

integrative theory has the potential to transform speech - even before

any work on speech is undertaken.

affects or relates to another, and particularly howit may influence the way in which articulators pro-

duce a target speech sound in an integrated fash-

ion. This is to say nothing of how a sound is then

produced in a word or sequence of words.

Developing isolated oral motor skills may

result in ongoing difficulties with the

integration of sensorimotor information

for the purposes of adapting to changing

oral and speech output demands (Pate &

Pinkstone, 1996).

EssentialEarly oral sensory motor experiences are

essential for developing oral motor plan-

ning skills (Pate & Pinkstone, 1996). They

also enhance the coordination of the

refined movement patterns required to

produce subtle sound changes forming

speech (Laurel & Windeck, 1989). Oetter et al

(1995, p3) have stated that Suck Swallow Breathe

(SSB) Synchrony is the fundamental sensorimotor

pattern and the primary oral motor mechanism.

As such, SSB synchrony is potentially a mechanism

by which skills that affect articulatory control can

be assessed and developed.

Rhythmical, coordinated sucking, swallowing

and breathing - or SSB synchrony - is the first

developmental pattern that requires timing and

sequenced movements (Oetter et al,1995, p3).

Getting

in synchwith suck,swallow, breathe

The level and natureof breakdown inplanning, coordinatingand integrating oral,pharyngeal, laryngealand respiratoryfunction is not likely to

be clear when isolatedoral motor skills areassessed.



sensory integration

Since suck, swallow and breathe are survivalbased, anatomically and functionally related

processes (Wolf & Glass, 1992), they are critical to

many elements of a childs development. Oetter

et al (1995) state that without the presence of

intact, underlying neuro-motor physiology (for

example, SSB; postural control) the development

of sound production and language may by dis-

rupted or disordered. In agreement, Selley et al

(1990, p326), when identifying factors common to

feeding and speech production (for

example, rhythm; oral and respirato-

ry control) have stated that a nor-

mally co-ordinated feeding mecha-

nism is an essential milestone in nor-

mal development, both for more

mature swallowing and for speech.

Pinkstone (1995), in a single case

study, hypothesised that SSB syn-

chrony is fundamental to competen-

cy in and the development of oral

sensorimotor and speech production

skills. A subject with developmental

verbal dyspraxia was provided with

increasingly complex oral sensori-

motor play experiences to facilitate SSB syn-

chrony. Statistically significant changes in the

subjects oral motor output resulted. Sound sys-

tem developments also occurred. Both develop-

ments were achieved without working directly on

oral motor or speech production skills. The inter-vention used was based on the M.O.R.E. tech-

nique, developed by Oetter et al (1995).

ComplexityThe M.O.R.E. technique provides a method for

assessing and developing suck swallow breathe

synchrony. This technique classifies oral play

materials in terms of the complexity of Motor (M),

Oral (O), Respiratory (R) and Eye/hand (E) involve-

ment. The oral and respiratory com-

ponents of the technique are most

important for clinicians working

with speech disordered children.

Each element of M.O.R.E. can be

graded in terms of 4 grades of diffi-

culty, with 1 representing the lowest

level of skills required, and 4 the

highest level. For example, the def-

inition of Grade 1, Respiratory

Demand (R), is: very little pressure

increase over regular breathing

required to produce sound or action

from toy; while Grade 4,

Respiratory Demand (R), is: consis-

tent deep breath and grading of air flow required

to change or produce sound or action (Oetter et

al, 1995, Ch 3, p5).

Using M.O.R.E., clinicians are able to:

assess oral (O) and respiratory (R) organisation

and coordination while a child is using a range oforal play materials (motor (M) and eye/hand (E)

coordination and control can also be assessed).

choose materials appropriate to a childs level of

oral and respiratory organisation and coordina-

tion.

plan intervention to facilitate sensory experi-

ences of increasing complexity and specificity to

the oral, pharyngeal, laryngeal and respiratory

areas.

directly shape the development of a childs suck,

swallow, breathe synchrony.

Intervention for suck swallow breathe asyn-

chrony does not require the subject to consciously

consider or monitor in isolation the initiation and

maintenance of breath support, voicing, articula-

tory movement and sound/word production. The

intervention programme aims to provide sensory

stimuli to the entire oral area, the pharynx, larynx

and the respiratory system and to replicate the

synergy characterising SSB synchrony. The provi-

sion of specifically tailored oral sensory input to

individual clients needs enables them to seek and

use more difficult oral sensory motor materials in

an adaptive manner. This is achieved as clients are

ready and able to do so and in a consistently moti-

vating, challenging and enriching context.

For an example of how an intervention pro-

gramme using the MORE approach and seeking to

facilitate SSB synchrony may look, see table 1.

The provision ofspecifically tailoredoral sensory input

to individual clientsneeds enables themto seek and usemore difficult oralsensory motormaterials in anadaptive manner.

Stage

1

2

3

4

Sensory experiences

Clients are provided with a range of sensory experiences through oral play.Opportunities to:a) initiate and maintain* blow and suck* oral motor and respiratory control.b) adapt responses to activity demand with more control and consistency.

Oral toys are now chosen for the

* level of SSB synchrony they can facilitate; for example, a flute versus a kazoo.* specific sensory experiences they can provide. For example, if a client has dif-ficulty grading blow (that is, moving from hard to soft blowing), then oral toysand sensory experiences which assist in this adaptation are made available.Toys for facilitating grading of blow may include a range of bubble blowers,

peashooters, blow-darts/pens, flip-flap balls.Appropriate support to achieve optimal functioning is also provided, such as

jaw support to encourage less bite and more lip closure/control on toys.

If the client is able to move from one adaptation to another, for example hardto soft to hard blowing, then it is time to move on to sensory experiences thatreinforce the ability toa) initiate and maintain* oral and respiratory organisation at the same level; for example, when askedto blow harder, the client can maintain oral control; when asked to change lipposture, the client is able to do this without losing respiratory control - forexample, lips behindthe mouthpiece of a trumpet versus lips overa trumpet.* oral and respiratory control across oral play materials, that is, not losing thelevel of control already achieved when moving from one toy onto another oraltoy, for example, from apenny whistle to a bubble blower.b) modify the grading of suck and blow according to specific demands.c) increase endurance and strength of suck, swallow and breathe.

Once SSB synchrony is achieved at most levels of demand and across a varietyof oral play materials - that is, it is an integrated, generalised skill - then it maybe appropriate to focus again on specific sensory experiences for the purposesof sound system development. For example, encouraging sucking and experi-mentation in the back of the mouth, to improve sensation to this area and toprepare the client for establishing placement for the velar plosives /k/ and /g/.

Outcome

* Observations reveal the level to which the client caninitiate and maintain control of oral and respiratoryfunction under differing circumstances. As a result,more specific input can now be planned.* Clients are highly motivated for a range of experi-ences with a wide range of oral play materials.

* Grading of oral and respiratory control may require

differing levels of support from the clinician.* A specific response may only be achieved followingsome attempts at achieving the target.* If the client has difficulty initiating a suck, differentmeans for eliciting a suck are attempted. The abilityto initiate a suck should be established by the end ofthis stage.* Clients become more confident and are more likelyto seek different sensory experiences spontaneously.

* The client is now able to grade with minimal sup-port from the clinician and usually as soon as a specif-ic response is requested.* For clients with difficulties initiating a suck, it maybe possible at this stage to move from drinking-basedsuck to other suck activities, for example sucking on astraw to move pieces of paper from one location toanother.* The following are increasing:==> Self-generated experimentation with oral playmaterials.==> Strength and endurance of oral and respiratorycontrol and coordination.==> Ability to modify oral and respiratory control tochanging demands with speed and accuracy.

The sensory experience of the feature/s of a sound -such as length (plosive vs fricative) - before thatsound is targeted, is likely to result in increased accu-racy and speed of target sound production. This maythen generalise to sound production in words and toother sounds with similar features.

Table 1: Stages of development in establishing and developing suck swallow breathe synchrony


12/32

sensory integration


Functional changeUsing this approach over a five year period, I have

found that, by developing SSB synchrony with

children with speech disorders (particularly motor

speech disorders such as developmental verbal

dyspraxia), more effective oral sensori-

motor planning and coordination has

resulted. Provision of appropriate and

high quality sensory experiences has

increased the clients ability to inte-

grate their sensory and motor respons-

es. The effect of the latter is to pro-

duce a marked refinement in oral

function both as a whole and for spe-

cific oral and speech movements.

Importantly, functional changes are

achieved without developing splinter

skills such as the ability to lick lips, and

in a setting where clients are not being asked to

produce oral motor or speech movements in isola-

tion (see case example).

Sensorimotor deficits potentially impact on oral

motor and sound system development and may

contribute to the continued presence of

speech/phonological impairments. The approach

presented in this paper may provide the basis for

the future development of assessments used with

speech disordered children. Certainly, interven-

tion strategies for speech disordered children pre-

senting with sensorimotor deficits can be

informed and challenged by the approach.

With many researchers agreeing that sensory

information or input is an integral part of move-

ment control and co-ordination (Van

der Merwe, 1997, p3), this approach

can potentially be used in the man-

agement of adult clients presenting

with speech motor difficulties, partic-

ularly where the sensory deficit is

clearly identified. The materials used

to facilitate SSB synchrony may differ

but the basic premise of utilising the

synchrony to elicit ever increasing

control and integration of oral motor

skills remains.

Future research into developmental

speech disorders should seek to

further investigate the relationship between

sensorimotor input deficits and motor/speech out-

put deficits.

provide diagnostic markers for the type and

level of sensorimotor breakdown in children pre-

senting with a range of speech disorders, particu-

larly motor speech disorders such as developmen-

tal verbal dyspraxia.

determine assessment techniques that more

directly measure sensorimotor skills of speech dis-

ordered children.

provide normative data regarding the develop-

ment of suck swallow breathe synchrony.

provide the evidence base to support the use of

sensory integrative assessment and intervention

strategies when managing developmental speech

disorders.

Olwen Pate is Principal Speech and Language

Therapist (Paediatrics) with Croydon and Surrey

Downs Community Health NHS Trust at

Sanderstead Clinic, 40 Rectory Park, Sanderstead,

CR2 9JN.

ReferencesAyres, A.J. (1979) Sensory Integration and the

Child. Western Psychological Services, USA.

Laurel, M. & Windeck, S. (1989) A Theoretical

Framework combining Speech-Language Therapy

with Sensory Integration Treatment. Sensory

Integration Special Interest Section Newsletter 12

(1) 1-5.

Oetter, P., Richter, E. & Frick, S. (1995) M.O.R.E.

Integrating the Mouth with Sensory and Postural

Functions. Hugo, MN: PDP Press, Inc.

Pate, O. & Pinkstone, M. (1996) Suck Swallow

Breathe Synchrony (SSB) and its Relationship to

Case example

Gary, 4.3 years, has a severe oral motor dyspraxia and phonological disorder. Hewas seen intensively for nine 30 minute sessions. Prior to intervention, his oraland respiratory organisation/control was limited and he was unable to suck.During intervention, once he had mastered oral play materials that requiredincreasing levels of oral and respiratory organisation and coordination for blow,he sought SSB activities that relied on the development of his suck. In the finaltherapy sessions he was able to suck drink up lengthy tubing (one to two metreslong) while standing up. The latter entailed him coordinating his breathing while

maintaining suck over periods of up to three to four minutes. Following interven-tion, oral motor assessment revealed there was an increase in Garys: postural, head and neck stability and control. jaw stability, allowing for isolation of oral movements. respiratory control and coordination. ability to initiate and sustain oral movements more effectively and to

coordinate oral movements with respiratory support.Assessment of Garys sound system revealed his phonetic inventory and phoneticdistribution had expanded. These expansions were integrated into Garys systemin both an idiosyncratic and appropriate fashion, as would be expected for asound system that continued to be disordered.

Examples of word initial position changesTarget Pre Post Target Pre PostHouse a Thumb m tmSun n n Saucer a saClown n n Sugar d daSock q Jam m mTeeth t Zip i ipChair a Mouth b mDress Girl d rl

Examples of word initial cluster developmentsSmoke ma ma Three wSnake nei snei Sleeping pi eipinSwimming imim imin Spoon un punBridge bid bwid Sweeties wiFlower wa aw Sky dai taiBlue bju blu Green n qwn

Examples of other changesMoney mn mn Baby bb beibPushing p phin Watch mw wtDoll da dl Fork u

this approach

can potentiallybe used in themanagement of

adult clients

presenting withspeech motordifficulties



sensory integration

Oral Sensory

Motor Control

and Speech

P r o d u c t i o n

Skills. Proceedings of the First International SI-

NDT Congress, Cape Town, South Africa.

Pinkstone, M. (1995) Suck Swallow Breathe

Synchrony: A single case study investigating the

relationship between oral sensory-motor control

and speech production in a dyspraxic child.

Unpublished project.

Selley, W., Ellis, R., Flack, F. & Brooks, W. (1990)

Coordination of sucking, swallowing and breath-

ing in the newborn: Its relationship to infant

feeding and normal development. British Journal

of Disorders of Communication 25 (1) 311 - 327.

Smith, A., Goffman, L. & Stark, R.E. (1995) Speech

Motor Development. Seminars in Speech and

Language 16 (2) 87 - 99.

Van der Merwe, A. (1997) A Theoretical

Framework for the Characterisation of

Pathological Speech Sensorimotor Control. In

McNeil, M.R. (Ed) (1997) Clinical Management of

Sensorimotor Speech Disorders. Theime, New

York.

Wolf, L.S. & Glass, R. P. (1992) Feeding and Swallowing

Disorders in Infancy, Assessment and Management.

Tucson, AZ: Therapy Skill Builders.

eflections

Do I give sufficient

onsideration to

he benefits of

nput as well as

utput therapy for

lients with oral /

peech motor

eficits?

Do I have the

ange of equipment

ecessary for

lients to develop

ral motor skills?

Do I explore the

otential of

heoreticalpproaches

mbraced by

elated professions?

Do your clients want more speech work than your time allows? Carol Bishops clients did, so she

developed Speech Sounds on Cue. This CD ROM provides multimedia cues for 531 consonant/

vowel and consonant/vowel/consonant words covering 19 consonant sounds in initial position.

Carol, senior speech pathologist at the Aged Care Rehabilitation Unit in Hobart, Tasmania,

designed the software for adults with dyspraxia, but it may also be suitable for children with dys-

praxia or Autistic Spectrum Disorder and people with a hearing impairment.

Speech & Language Therapy in Practice has a copy of Speech Sounds on Cue to give away FREE

to a lucky subscriber, courtesy of its UK distributor, Propeller Multimedia Ltd. It normally costs 90

+ 5 delivery + VAT for single copies.

To enter, simply send your name and subscriber number / address marked Speech Sounds on

Cue to Avril Nicoll, 33 Kinnear Square, Laurencekirk AB30 1UL, tel. 01561 377415, e-mail avrilni-

[email protected] by 14th October, 2000. The winner will be drawn randomly from all valid

entries.

*The program is operated using a mouse, touchscreen or simple keyboard control.Recommended specifications: IBM PC running Windows 95 and above. Pentium 200 Mhz with 32

MB RAM, 24 bit true colour, 16 bit sound card and speakers and 16 speed CD-ROM drive.

Will also run on Apple Macintosh G3, 32 MB RAM, System 8 or later, 16 speed CD-ROM.

Speech Sounds on Cue is available from Gordon Russell, Propeller Multimedia Ltd. P.O.

Box 27028, Edinburgh, EH10 6WD, Scotland, tel/fax. 0131 446 0820,

www.propeller.net/react

Do you want a comprehensive measure of language skills for

clients in the age group 6-21 years? The Clinical Evaluation of

Language Fundamentals (CELF) has now been adapted and stan-

dardised for use in the UK, and Speech & Language Therapy in

Practice has a copy to give away FREE to a lucky subscriber, cour-tesy of The Psychological Corporation. It normally costs 345.20.

To enter, simply send your name and subscriber number / address marked CELF to Avril Nicoll,

33 Kinnear Square, Laurencekirk AB30 1UL, tel. 01561 377415, e-mail [email protected]

by 14th October, 2000. The winner will be drawn randomly from all valid entries.

CELF-3UK

is available from The Psychological Corporation, FREEPOST WD147, HarcourtPlace, 32 Jamestown Road, London NW1 1YA, tel. 020 7424 4456.

1. Entrants must subscribe personally or as one of a department to Speech & Language Therapy inPractice, and only one entry per subscriber number is allowed.

2. Entries must be received by the editor on or before 14th October, 2000.3. The winner will be randomly selected from all valid entries.4. The winner will be notified by 21st October, 2000.5. The winner will have access at work to suitable computer hardware.*6. The winner will review Speech Sounds on Cue for Speech & Language Therapy in Practice by a date

agreed with the editor.

1. Entrants must subscribe personally or as one of a department to Speech & Language Therapy inPractice, and only one entry per subscriber number is allowed.

2. Entrants must be registered speech and language therapists.3. Entries must be received by the editor on or before 14th October, 2000.4. The winner will be randomly selected from all valid entries.5. The winner will be notified by 21st October, 2000.6. The winner will review the CELF-3UKfor Speech & Language Therapy in Practice by a date

agreed with the editor.

Win Speech Sounds on Cue

Win CELF3UK

Congratulations to Carol-Anne Murphy who

won Clicker 4, and to Mrs L. Collier, Debbie Rai, Margaret Rooney and Hilary Jarvie who

won photocopiable resources from Black Sheep Press in the Spring 00 issue of Speech &

Language Therapy in Practice.

Previous winners...

..READ

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O

FFER

S..READ

ER

O

FF

ERS..READ

ER

OF

FERS..READ

ER

O

FFERS..

COMPETITIONRULES:

COMPETITIONRULES:

picturesposedbymodels


14/32

Colorcard resourcesEDUCATION

All from Winslow

Pocket Colorcards

Early Objects, Early Actions, Early Sequences, Early

Opposites

19.95 for fourThe best thing about these is their size as the playing-card

sized photographs fit inside fishing games and post-boxes

with ease! They have been produced especially for chil-

dren so the objects, actions, concepts (pairs of pictures

such as big/little) and sequences (three-part, for example

having a haircut) are all appropriate to this client group.

These are excellent value and a must for anyone working

with preschool or primary-aged children.

Whats Inside?

24.95This set contains pairs of cards, one of which shows the out-

side of a container (such as a fridge, school bag, first-aid

kit) and the other its contents. Children enjoy using this

resource to work on vocabulary, categorisation, prediction

and descriptive skills and it will be most useful to therapists

working in mainstream and special school settings.

What Is It?

28.75These are object photographs with two smaller pictures

that show parts of the object (a computer has smaller pic-

tures of the keys and the mouse) or the object from an

unusual viewpoint (a wellington boot is viewed frombelow and behind). This provides effective but limited

ways to work on vocabulary, descriptive skills and spatial

concepts with school-aged children.

Sequencing Sounds

35.50

This activity involves matching sequences of sounds (sup-

plied on cassette tape) to pictures. The two and three-

sound sequences include eating crisps and scrunching up

the packet and playing a drum, xylophone and maracas.

Although useful for working on listening skills there are

limited ways in which this material could be presented.

Using Colorcards in the classroomISBN 0 86388 188 2 9.95 This book provides a practical collection of ideas for using

Colorcards (or similar resources) to develop listening and

attention, comprehension, vocabulary, expression,

sequencing, and social skills. The aim of each activity is

clearly stated along with suggestions for varying the level

of difficulty. The index allows you to select activities to

link in with the National Curriculum (Key Stage 1 and 2).

This book is most useful as a resource for teachers and

assistants working in mainstream or special schools but is

also worth a glance by speech and language therapists

looking for some new ideas.

Diane Stanger is a speech and language therapist with

Sussex Weald & Down NHS Trust.

Essential reading

Parkinsons Disease - Studies in

Psychological and Social Care

Ed. Ray Percival and Peter Hobson

The British Psychological Society, tel. 0116

254 9568

ISBN 1 85433 299 6 12.95

This interesting and readable book opens with an

excellent introduction to the nature and courseof Parkinsons Disease. The following chapters

represent a sample of recent research into the

needs of people with Parkinsons and those of

their carers and families.

The second half covers assessments and inter-

ventions including psychological groups, support

networks, communication, swallowing, and a

useful chapter on driving.

This book describes in detail the full impact of

Parkinsons Disease on peoples lives. It should be

essential reading for anyone who provides, or is plan-

ning to provide, a service to people with the disease.

Sue Chorlton is a speech and language therapist

at Weston General Hospital, North Somerset.

reviews


A revelation

Have I Got Views For You!Joan Murphy

University of Stirling, tel. 01786 467645,

e-mail [email protected]

ISBN 1 85769 0990 25

For people with Motor Neurone Disease whose

ability to communicate is limited, this framework

to enable them to discuss their quality of life is a

revelation. As such it is very relevant to the

speech and language therapists work. The

instructions for its presentation to the MND suf-

ferer are clear. The delightful materials do not

take an inordinate amount of time to prepare.

As a retired speech and language therapist who

now works as a Volunteer Visitor for the Motor

Neurone Disease Association, my role is about

quality of life issues in particular. Thus I found

this easy to administer framework an excellent

way of helping sufferers reveal needs which

could not have surfaced in any other way.

A future edition could include details of the

Motor Neurone Disease Association as well as the

Scottish Motor Neurone Disease Association, as it

provides services and information for people liv-

ing in the rest of the UK.

I consider this package value for money and rec-

ommend it thoroughly.

Adrianne Marks is a retired speech and language

therapist, formerly at St Marys Hospital, London and

the Domiciliary Service of Parkside Health Authority.

REVIEWS. . . . . . . . . . . . . .r e v i e w s

Help me Talk Right

How to Correct a Childs

Lisp in 15 Easy Lessons

(0-9635426-0-5)

How to Teach a Child to Say

the R Sound in 15 Easy

Lessons (0-9635426-1-3)

How to Teach a Child to Say

the L Sound in 15 Easy

Lessons (0-9635426-4-8)

Mirla G. Raz.

Gersten Weitz Publishers, tel.(480) 951 9707,

www.speechbooks.com /www.thinkingpublications.com

$32+shipping (each)

These three books are designed

so non-professionals can use them

under a therapists supervision. It

is not dynamic therapy - and the

sixteen small black-and-white pic-

tures per page are not inspiring -

but they are easy to follow with

useful trouble shooting sections.

They progress logically from

teaching tongue positions, to pro-duction of each sound in isola-

tion, in different positions in sylla-

bles and words, then in sentences

and consonant blends and finally

carry-over into conversation.

However, placing the tongue

behind the bottom teeth for /s/ is

controversial and the emphasis on

motivating through monetary

gain questionable.

Another limitation is the

American vocabulary with which

most English children will be

unfamiliar. Most therapists

already have a wide range ofmaterials for these sounds. Given

budget limitations and the high

number of serious communication

disorders on most caseloads, I

would not recommend these

books for UK therapists.

Nevertheless it is useful to have a

relatively tailor-made package for

minor speech problems and they

are reasonably priced.

Janet Farrugia runs an indepen-

dent speech and language thera-

py practice in Bookham, Surrey.

Easy to follow,but not dynamic

ARTICULATION

PROGRESSIVE NEUROLOGICAL

PROGRESSIVE NEUROLOGICAL


15/32

Easy to read and use

Cognitive Neuropsychology and

Conversation Analysis in Aphasia. An

Introductory Casebook.

R. Lesser and L. Perkins

WhurrISBN 1 86156 068 0 24.50

This practically-based workbook does not dwellon theory and is easy to read and use. The aim is

to demonstrate how the integration of

Cognitive Neuropsychology and Conversation

Analysis can provide rationally motivated apha-

sia therapy. A basic working knowledge of the

approaches is assumed although brief overviews

of both are given.

The authors present six real case studies and

ask the reader to suggest initial hypotheses,

assessments, interpretation of results and

approaches to therapy. Photocopiable work-

sheets are provided. At each stage, the reader

can compare their ideas to those presented by

the authors. Answers are therefore providedbut the authors clearly expect and encourage

variations.

This book is a valuable and reasonably-priced

resource for aphasia therapists aiming for a

structured balance between impairment-

focused therapy and a more functional interac-

tion-based approach. It is designed to provide a

constant source of reference and would benefit

experienced practitioners, newly-qualified ther-

apists and students on placement.

Kit Barber is a specialist speech and language

therapist working with community-based adults

for North East Wales NHS Trust.

ADULT NEUROLOGY

Enthusiastic and personal

Reasons and Remedies

Patricia SimsMortimore Books, PO Box 156, Barnstaple,

EX33 1YN

ISBN 0-9536209-0-5

12.95 (10.95 if ordered directly)

Speech, language, learning and social prob-

lems, such as stammering, dyslexia and autism,

need no longer be puzzling. If we enquire in

some depth into the personality traits of young

children, we will discover mechanisms which lie

behind such problems.

In her long career with special needs children,

Patricia Sims has developed her holistic method

of working which she says has increased success

of therapy as well as her own job satisfaction.

The book includes a very comprehensive,

detailed checklist for case history taking and many

vignettes from cases to illustrate her theories.

A very enthusiastic and personal book. Easy to

read, it should stimulate creative thought, how-

ever experienced the reader.

Rosemary Fisher specialises in dysfluency in

adults and children. She works in Derby.


reviews

Raises awareness

Fragile X Syndrome - An Introduction

Fragile X Society, tel. 01424 813147

Video+booklet 5.00This twenty minute video aims to help profes-

sionals know when to suspect Fragile X may be

present, understand its effects, and initiate early

multidisciplinary evaluation, intervention and

support.

Interviews with professionals and parents,

together with film of those affected, demon-

strate and explain the characteristics effectively.

The accompanying booklet explains more about

speech and language than does the video. The

many benefits and implications of diagnosis are

discussed, and there is a positive emphasis

throughout.

A useful and good value resource to share with

colleagues, and to raise our own awareness of

the condition, the characteristics of which have

management implications.

Fiona Ashford is a speech and language thera-

pist working in the Special Needs Team in

Portsmouth Healthcare NHS Trust.

Enjoyable, with excellentillustrations

More Than Words (Helping Parents

Promote Communication and Social Skills

in Children with Autistic Spectrum

Disorder)

Fern Sussman

The Hanen Centre; available from WinslowISBN 0-921145-14-4 26.95 + p&p

This is a valuable resource book for any therapist

who has contact with children with autistic spec-

trum disorder.

Following a similar format to the original

Hanen It Takes Two To Talk, it establishes the dif-

ferent stages of communication and essentials

for good communication (OWLing - observing,

waiting, listening - and additional new

acronyms) and then moves on to useful exam-

ples of how to develop play and share books or

music.

In addition, it addresses specific aspects associ-

ated with autistic spectrum disorder, such asexplaining sensory-motor preferences and the

way the children acquire information. Especially

useful are the examples of adapting language

and using augmentative communication.

A well-priced, easy and enjoyable read with

excellent illustrations, it has well structured

examples of functional ideas for parents to try.

Fiona Coughlan works for Warrington

Community Health NHS Trust with preschool and

primary school children with special needs.

AUTISTIC SPECTRUM

Informative and inspiring

Fluency courses at the Apple House,

Oxford, 1966 - 1998 - An Evaluation

Dr Rosemary Sage

The Stammer Trust

ISBN 0 9534807 0 4 7 inc. p&pThis clear, readable account of thirty years of

evolving stammering therapy at Apple House

begins with a succinct history of stammering and

goes on to give brief summaries of recent

research. Results of different approaches to ther-

apy are included and discussed.

The second half concerns itself with the numer-

ous aspects of running the courses at Apple

House. Four case histories are included with a

summary and evaluation of the therapy program.

This report combined the scientific with the

therapeutic in an informative and inspiring for-

mat. The richness of the therapists and clients

experiences was quite enviable. This report is

excellent value for money and I recommend it to

students and therapists alike.

Amanda Mozley is head speech and language ther-

apist at Chelsea and Westminster Hospital, London.

Invaluable software

Boardmaker

Mayer-Johnson plc

250 plus VAT

Available for Apple Macintosh or Windows

Version evaluated: Boardmaker for WindowsThis computer programme, containing over 3000

picture communication symbols, allows you tomake attractive communication boards and dis-

plays suitable for use with children and adults. It

comes with a clearly written users guide and an

excellent 60 minute instructional video.

With the programme you arrange cells - boxes

in which you place picture symbols - anywhere

on a page; make them different sizes; change

their border colours - useful if you want to say

colour code nouns and verbs; display text with

your symbol in up to two languages -

Boardmaker comes with ten; plus you can add

your own text and other language fonts. You

can also make your own symbols or bring pho-

tographs into the programme.As with any programme there were one or two

initial headaches in using it, and some of the sym-

bols arent quite appropriate for the UK; for exam-

ple the word goal produces a picture symbol quite

unlike any set of goal posts Ive seen in this country.

Verdict: an easy to use and invaluable piece of

software which produces attractive materials.

Neil Thompson is a speech and language thera-

pist in mainstream schools and schools resourced

for children with medical needs/physical disabili-

ties. He works for Newham Community Health

Services NHS Trust, East London. He won

Boardmaker in the Winter 99 reader offer of

Speech & Language Therapy in Practice.

DYSFLUENCY

LANGUAGE DEVELOPMENT

CHILD DEVELOPMENTSYNDROMES


16/32

or the past six years the Department of

Human Communication Science atUniversity College London (UCL) has been

developing an approach to speech and

language therapy students professional and clin-

ical learning which emphasises active participa-

tion from the earliest stages of clinical placements

(Morris, 1998; Parker & Kersner, 1998). We have

been moving towards emphasising reflective

cycles of learning which integrate practice, theory

and rehearsal, rather than the traditional linear

model with its expectation that theory and obser-

vation should always precede practice (Schon,

1983, 1987; Kolb, 1984; Stengelhofen, 1993;

Morris & Parker, 1998). Speech and language ther-

apy students reported experience of learning

more effectively through active participation is

supported by Erauts work on the relationship of

practice with theory in professional learning (for

example Eraut, 1994). Real responsibility helps the

development of confidence and allows students

to gain a deeper understanding of related theory

(Kersner & Parker, 1999).

One application of this approach has involved a

partnership with the Stroke Association Dysphasia

Support Service in London. The placement was

first set up in 1997, and is completed by under-

graduate Speech Sciences students as a prepara-

tion for their main final year placement with

speech and language therapy services for clients

with acquired disorders of speech, language and

cover story


Read this if you:want innovative

ideas for trainingbelieve student

training shouldalso benefitclients

are interested inworking with thevoluntary sector

Research shows individuals learn more

effectively when given responsibility and

encouraged to participate actively. Suzanne

Beeke andAnn Parkerare behind an innovative

programme where speech and languagetherapy students become temporary volunteers

for the Stroke Association. Here, they explain

how this has benefited the people living with

dysphasia as much as the students.

Fvoice. The design and organisation of the place-

ment has just been revised in the light of an auditcarried out in the summer of 1999.

Students are assigned, in pairs, to work with one

of the London Stroke Associations Dysphasia

Support groups, which are affiliated with the

Stroke Association Dysphasia Support Service. The

dysphasia support organiser acts as their supervi-

sor for the duration of the four week placement.

Non-local speech and language therapy supervi-

sion is provided by a member of the clinical staff

at UCL.

Support and practiceEach pair of students assists the dysphasia support

organiser in planning and running the weekly

stroke group, and also makes visits to certain

group members who have requested that a

Stroke Association volunteer visit them at home.

Each pair of students visits two people twice a

week for approximately one to one and a half

hours per visit. During this time students work as

Stroke Association volunteers, fulfilling the objec-

tives of the Dysphasia Support Service by provid-

ing support with, and practice of, communication

for the stroke person in their own home (The

Stroke Association, 1999). Verbal and written

information which clearly states that students are

not qualified or expected to provide speech and

language therapy is given to the dysphasic indi-

viduals, their family members, the dysphasia sup-

port organiser and the students before the place-

ment begins. The programme specifies that stu-dents must only visit individuals who are not

being treated by a speech and language therapist

during the time when visits will take place.

The placement aims for students to:

1.develop the ability to interact with adult

clients

2. experience working as a volunteer within a

community-based service for clients with

dysphasia

3.be aware of the psychosocial and practical

aspects of life for people with dysphasia, and

for their families

4.develop a problem-solving approach to

clinical work5.continue to develop independent learning

skills

6. enhance the ability to seek and act on

feedback on performance from a range of

sources, including the client, family members

and professional colleagues

7.enhance the ability to take responsibility for

day-to-day organisation of home visits,

session planning, administration tasks and

report writing

8.continue to develop pair-work skil

Speech & Language Therapy in Practice, Autumn 2000

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Transcript of Speech & Language Therapy in Practice, Autumn 2000