Speech & Language Therapy in Practice, Summer 2001

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SUMMER 2001

StorytellingA multidisciplinaryplot

SensoryintegrationReady fortherapy

Peer support

A journey withchronic fatigue

In myexperienceSociology

How (and why)I workindependently

RCSLTConferenceKey messages

D E V E L O P Y O U R I M A G I N A T I O N

http://www.speechmag.com

In thespotlightA multisensory

approach

ISSN 1368-2105


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Summer 2001 speechmagNow with a search facility! Key in anyword(s) and very quickly you will be guidedto relevant areas of the site.

New articleIn the Summer 2001 issue, Keith Parkdiscusses the value of storytelling forclients and for building multidisciplinaryteams. See www.speechmag.com for anexample from Marie Savill of thisapproach in practice with a studentcalled Natasha. Humbug, ghosts,partying and nuts all feature...

Reprinted articles to complement theSummer 2001 issue of Speech& Language Therapy in PracticeChild dysphonia - harmony and balance.(Aug/Sept 1996, 5 (4))**In the light of their voice care programme, JennyHunt and Alyson Slater ask if therapists should beafraid of working with dysphonic children.

Building an internal framework.(Feb/Mar 1997, 6 (2))**Barbara Larkham and Elaine Jeffers evaluate acontrastive metasyntactic approach to developing

knowledge of English syntactic rules in a group ofprofoundly deaf teenagers.

Assessment and therapy with adults.(Sept 1987, 3 (2))*Joan Murphy found herself devising an assessmentprogramme for adults with mental handicap whenshe was asked to advise on their speech.

From Speech Therapy in Practice* / Human Communication**, courtesy ofHexagon Publishing, or from Speech & Language Therapy in Practice***

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issues and news about the next one,links to other sites of practical valueand information about writing forthe magazine. Pay us a visit soon

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A comprehensive and practicalresource, Working with Adults with aLearning Disabilitycovers all aspects ofworking with this client group.

Written by Alex Kelly, authorof Talkabout, it includes An introduction to learning

disability Assessment of clients and

their environment Augmentative and

alternative communication Social skills Dysphagia.Each section gives the readera theoretical background,practical suggestions and for-mats for assessment and aguide to intervention, as wellas a clear and worked-outexample. In addition, theauthor addresses staff train-ing, group therapy, accessing

the criminal justice system and working with a multidisciplinary team. Auseful inclusion is a revised version of The Personal Communication Plan,as well as a users manual.

The normal retail price is 34.95 but Speech & Language Therapy inPractice has FIVE copies to give away FREE to lucky readers, courtesy ofSpeechmark Publishing Ltd.

To enter, simply send your name and address marked Speech &Language Therapy in Practice - ww learning disabilities offer to SuUnderhill, Speechmark, Telford Road, Bicester, OX26 4LQ. The closingdate for receipt of entries is 25th July, 2001, and the winners will benotified by 31st July.

Working with Adults with a Learning Disabilityis available, along with afree catalogue, from Speechmark, tel. 01869 244644, fax 01869 320040,e-mail [email protected].

Win Working withAdults with a

Learning Disability

Previous winners...The winners of Reasons and Remedies and accompanying PersonalityChecklist in the Spring 00 reader offer are Katie Parrott, Jean Lindsay,Margaret Lines, Clare Attrill and Siobhan Young. In the same issue, thePsychological Corporation offered a copy of the Preschool and PrimaryInventory of Phonological Awareness (PIPA) - this was won by JeanLindsay. Congratulations to you all, and especially to Jean who can nolonger say But I never win anything...

http://www.speechmag.com

www.speechmag.com

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3/32SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2001 1

16 Sensory integrationClaire was a very agitated little girl who was usuallyover aroused, constantly on full alert and difficult to

calm. The aim of treatment was to get her into anoptimal state of arousal for a functional activity:taking food off the spoon without distress.In the first of two articles (Spring 2001 issue), SarahBarnes explained how to recognise sensory deficits inchildren. In this second article, she demonstrates whyhelping a child to achieve an optimal level of arousalis crucial to the success of intervention.

19 Conference CallKnow your values; involve users; think differently;develop partnerships; have evidence-based vision.Avril Nicoll reports on five of the key messages forpractice she took away from the Royal College of

Speech & Language Therapists SharingCommunication conference.

20 A journey with chronicfatigueWe received a variety of therapeutic advice from anumber of reputable sources but eventually had tofeel our own way forward...this article is not prescriptiveand certainly does not hold all the answers, but isintended to lend you the kind of support which wegreatly valued from each other.

Jane Patrick and Madeline Atherden on theirwork with two teenage girls with

aphonia associated with chronicfatigue syndrome.

24 FurtherreadingChild language, dysarthria, AAC, edu-cation, dysphagia.

25 How (andwhy) I workindependentlyI remain committed to the

independent sector despitethe enormous challenge it has posedand continues to pose - or maybebecause of it? Heres to the nextone - Accreditation!

Janet Farrugia, Julie Andrews and MariaFarry discuss what working independentlymeans to them and their clients.

SUMMER 2001(publication date 28th May)

ISSN 1368-2105

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

Production:Fiona Reid

Fiona Reid DesignStraitbraes FarmSt. CyrusMontrose

Website design and maintenance:Nick BowlesWebcraft UK Ltdwww.webcraft.co.uk

Printing:Manor Creative7 & 8, Edison RoadEastbourneEast SussexBN23 6PT

Editor:

Avril Nicoll RegMRCSLT

Subscriptions and advertising:Tel / fax 01561 377415

Avril Nicoll 2001Contents 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.

Inside coverSpring 01 speechmag

Reader offerWin Working with adults with a learning disability.

2 News / Comment

4 A multidisciplinary plotStorytelling, it seems, is a vital ingredient of humanexperience. But if this is so, how can we do storytellingwith people who have

sensory impairmentsand additionaldisabilities? Why

should we bother?As a uniquely human

and social experienceenjoyed by all, KeithPark suggestsstorytelling is an idealvehicle for promotingmultidisciplinarycollaboration.

8 ReviewsAssessment, speech difficulties, psycholinguistics,progressive neuro, voice, hearing impairment, AAC,child language.

14 In My ExperienceBecoming a speech and language therapist does not

solely concern the acquisition of clinical knowledge

and the test of clinical competence; the adoption of aholistic approach marks a shift towards a morehumanistic concern with communication.

Sarah Earle argues that sociology is essential ifstudents are to become reflective practitionerswith an appreciation of the value of research andan understanding that successful communicationis influenced by social factors and access to services.

ContentsSummer 2001

Cover picture by Paul Reid.The spotlight is on squeezing.Thanks to models Joanna and Connor andInverbrothock Primary School, Arbroath.

See page 10 Spotlight on Language

www.speechmag.com

IN FUTURE ISSUES LARYNGECTOMY NEURO-DISABILITY INFANT FEEDING

EARLY YEARS INTERVENTION DEMENTIA LEARNING DISABILITY

Spotlight on languageThe idea behind the Spotlight stems from using different colouredbeams in a special torchlight as if it were a spotlight on part of a

scene in a theatre, but instead used on pictures or actions.SPOTS-ON, a multisensory approach to language intervention, isrelevant to any client with a language difficulty. Carole Kaldor, JanetTanner and Pat Robinson highlight its benefits and applications.

10 COVER STORY


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Therapyfor deafchildrenA new booklet informs parentsabout speech and language therapyfor deaf children in England andWales.The 16 page publication from theNational Deaf Childrens Societyemphasises that speech and lan-guage therapy is part of an individ-uals communication developmentprogramme and is as relevant forchildren who are signing as forthose who are not. Speech and lan-guage therapy is recommended forchildren with a cochlear implantand for deaf children with commu-nication problems, including thoseassociated with glue ear. It goesinto some detail about how parentscan ensure their child gets the ther-apy they need - and what to do ifthey do not - but reminds parentsthat speech and language therapy isabout more than just time spentwith the therapist.Speech and Language Therapy forDeaf Children in England and Walesfrom NDCS, tel. 020 7490 8656,

www.ndcs.org.uk.

SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 20012

news

Complete the jigsaw is an appeal for a National

Encephalitis Resource Centre.The design has been broken into 1000 pieces to repre-sent the difficult and complex task of trying to pieceones life together following the illness. One piece willbe placed in the jigsaw for every 100 donated, withthe contributors name appearing on the completed

jigsaw which will be framed and displayed in thenew resource centre.Encephalitis means inflammation of the brain andoccurs in people of any age, usually as a result of aviral infection.

The Encephalitis Support Group,tel. 01653 699599, http://glaxocentre.merseyside.org/enceph.html

Encephalitis appeal

StrokeunitswelcomedThe Stroke Association is estimating

that 2500 lives will be saved eachyear and 3500 stroke patients willsuffer less disability with the intro-duction of stroke units acrossEngland.The National Service Framework forOlder People expects all generalhospitals to have a specialist strokeservice by April 2004. It sets outstandards for stroke care for all agesat all stages from prevention tolong-term support, with the devel-opment of intermediate care ser-vices a priority.

Research has shown that patientswho go into stroke units spend lesstime in hospital and are 25 per centmore likely to survive their strokeand suffer less disability; they alsohave a reduced risk of needinglong-term institutional care. ChiefExecutive of the Stroke Association,Margaret Goose, says, The provi-sion of stroke services across thecountry has been haphazard for fartoo long. We now have a realopportunity to organise andimprove the care patients and car-ers receive both in hospital and in

the community. However, the char-ity is concerned that the shortage oftrained therapists may mean thatsome stroke patients miss out.National Service Framework, seewww.doh.gov.ukThe Stroke Association, tel. 0207566 0317, www.stroke.org.uk.

A new website is designed to make gardening easier for everyone.Created by Thrive, the national charity that promotes the use of gardening andhorticulture to improve lives, the site includes information on special tools,easy access and maintenance tips, a text-only facility and a feedback section.Meanwhile, a speech and language therapy assistant who is a Thrive supporterhas spent an afternoon bringing the joys of an indoor sensory garden to peoplewith learning difficulties who rely on AAC to communicate. Sheila Samsonused Boardmaker software to make very clear and explicit symbols aboutsensory gardening and stages of growth, as well as the five senses.The 15-strong Hot Gossip group also received donations of plant samplesfrom the Dundee University Botanic Gardens, and were able to smell, touch,see and hear such plants as coffee, cacti, trumpet tree, thyme, bay, rosemary,

lipstick, orange, lily, hellebore, jasmine and prickly pear. To stimulate theirsense of taste they sampled fruit and vegetables including lychees, mango,physallis, strawberries, tomatoes, mushy peas and prunes.Sheila says, The afternoons activities were great fun and stimulated lots ofinteresting conversation. We rounded up the day by signing and singing thesound track from the film The Jungle Book which we felt was suitably green!Thrive, tel. 0118 988 5688, www.thrive.org.uk; www.carryongardening.org.ukSheila Samson, tel. 01382 346005.

Carry on

gardening



news & comment

Just imagineSarah Earle (p.14) exhorts us to find our sociological imagination so we canunderstand where other people are coming from and facilitate access toservices. At the Royal College of Speech & Language Therapists Conference(p.19), Sally Byng argued that addressing mismatches between personalvalues and those of a service should lessen the professions retentionproblem. She recommended we work in a more holistic way, drawing ondisciplines such as sociology.A more holistic and imaginative approach allows Sarah Barnes (p.16) to take astep back from a clients immediate communication and feeding difficulty.Working closely with occupational therapists, she ensures clients are first atthe optimal level of arousal to enable them to benefit from more specifictherapy.Is imagination our most powerful yet often latent skill? Louise Coigleybelieves so. She held participants spellbound at her storytelling workshop atthe RCSLT conference with her book of invisible stories and herdemonstration of the importance of role, ritual, rhythm, rhyme andrepetition for slowing, calming and healing. Although it seems an impossibletask for something so participative, Keith Park(p.4) succeeds in conveying theenormous sense of fun a storytelling workshop produces among people of allabilities, and the potential it has to improve multidisciplinary working. Anexample of this approach in action is on www.speechmag.com, themagazines complementary website.

A link to the speechmag website appears on a new Internet portal underdevelopment at http://www.nelh.nhs.uk/speechtherapist/portal.htm. TheInternet is proving invaluable to the Association of Speech & LanguageTherapists in Independent Practice in directing clients towards an appropriatetherapist. At the start of their careers,Janet Farrugia, Julie Andrews andMaria Farrydidnt necessarily imagine they would move into the privatesector, but in How (and why) I work independently(p.25) they give us someinsight into the variety of ways speech and language therapists can developas independent practitioners.It is easier to find peer support in the NHS than in independent practice but,for more unusual and long-term cases, you may actively have to seek it out.Although they received a variety of advice on appropriate management,JanePatrickand Madeline Atherden (p.20) eventually had to feel their way withtwo teenage girls who had aphonia associated with chronic fatigue, peer

support stimulating the imagination.Inspiration can strike anywhere, anytime if you have an open mind. CaroleKaldors SPOTS-ON communication system (p.10) is a flexible, multisensorytool which uses the attractions of a theatre spotlight to draw attention toaspects of language. Carole talks about the life in the shared communicationbetween therapist and client and how this can benefit from the therapistcoming up with their own activities.At the conference, Claire Topping quoted four forces for maintaining thestatus quo: established practice; fear of change; confidence in well-learnedskills; complacency. By unleashing our imagination, we have a powerfulopposing force for change.

...comment...Avril Nicoll,

Editor

33 Kinnear Square

Laurencekirk

AB30 1UL

tel/ansa/fax 01561

377415

[email protected]

m

Asperger awarenessThe introduction of a new character to a televisionprogramme is increasing childrens awareness ofAsperger syndrome and how they can help.Grange Hillis CBBCs longest-running drama. Martinis a Year 7 pupil whose social communication diffi-culties make him a target for bullying. The NationalAutistic Society has produced a fact sheet aimed atyoung people aged 11-14 years to complement theprogramme. It is designed to raise awareness, giveadvice and inform pupils who may want to help aclassmate with Asperger syndrome. It can also beused as part of a lesson plan or with youth groupssuch as scouts or guides. The suggestion Be a buddyis included with advice about where to go for fur-ther information. Resources such as websites, booksand videos are also recommended.The National Autistic Society website now features asection dedicated to young people.NAS tel. 0207 833 2299, www.nas.org.uk.

Evidence-based practiceAdvice is available to help health care professionalsmake full use of research to ensure their practice isevidence-based.A bulletin from the NHS Centre for Reviews andDissemination addresses the problem of busy clini-cians accessing the best available sources of researchevidence on clinical effectiveness. It recommendssearching key focused resources such as theCochrane Library and summaries of research evi-dence along with using libraries and search servicesand seeking training in search skills.Effectiveness Matters 5 (1), February 2001, tel. 01904 433648.Cochrane Library www.update-software.com/cochraneClinical Evidence www.evidence.orgEffective Health Care bulletins www.york.ac.uk/inst.crd.

Access improves attitudesInvestment in access to education for disabled chil-dren is paying dividends.A report from the National Union of Teachers andthe charity Scope found that, in 90 per cent of schoolscovered by the Schools Access Initiative, pupils haveimproved attitudes to those with disabilities. It alsoshowed that schools and education authorities feelmore positive about the inclusion of disabled chil-dren than they did in 1992 when the first survey onaccess was published. It recommends continuingGovernment investment in the initiative which iscredited with improving access to the curriculum and

providing opportunities for long-term friendships.Within Reach 3 15 organisations / 5 individuals fromScope, tel. 020 7619 7341 or see www.teachers.org.uk.

Toy libraries fundedAround 150 new toy libraries are to be created foryoung children in deprived areas in England.Parents will be able to borrow toys and play equipmentand many libraries will offer onsite play facilities andcare support for young children, including thosewith special needs. The libraries will be run by a mix-ture of volunteers and paid staff. Some will bemobile for families who have difficulties travelling.The project is supported through the European

Social Fund and is to cover set-up costs.


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multidisciplinary work


his article describes a one day coursewhich aimed firstly to present someideas on interactive storytelling forindividuals with severe and profoundlearning disabilities, and, secondly, toexplore how this activity might serve

as a basis for multidisciplinary collaboration.There were about 45 participants who were froma wide range of professions who work with chil-

dren and adults with severe and profound learn-ing disabilities: speech and language therapists,teachers, support workers, audiologists, physio-therapists, and so on.

The reason for the first aim is illustrated byMeat of the Tongue, a Swahili story from AngelaCarters collection of fairy tales (Carter, 1991),which tells of a sultan whose unhappy wife growsleaner and more listless every day. The sultan seesa poor man whose wife is healthy and happy, andhe asks the poor man his secret. Very simpleanswers the poor man, I feed her meat of thetongue. The sultan immediately orders thebutcher to buy the tongues of all the slaughtered

animals of the town, and feeds them to his wife.The queen gets even more thin and poorly. Thesultan then orders the poor man to exchangewives. Once in the palace, the poor mans wifegrows thin and pale. The final part of the storygoes as follows:

The poor man, after coming home at night,would greet his new (royal) wife, tell her aboutthe things he had seen, especially the funnythings, and then told her stories which made her

shriek with laughter. Next he would take hisbanjo and sing her songs, of which he knew agreat many. Until late at night he would playwith her and amuse her. And lo! the queen grewfat in a few weeks, beautiful to look at, and her

skin was shining and taut, like a young girls skin.And she was smiling all day, remembering themany funny things her new husband had told her.When the sultan called her back she refused tocome. So the sultan came to fetch her, and foundher all changed and happy. He asked her whatthe poor man had done to her, and she told him.Then he understood the meaning of meat of thetongue (Carter, 1991, p 215).

Uniquely humanStorytelling, it seems, is a vital ingredient ofhuman experience. But if this is so, how can wedo storytelling with people who have sensoryimpairments and additional disabilities? Whyshould we bother? Jean Ware provides ananswer when she suggests that, in choosing activ-ities for people with profound and multiplelearning difficulties, our aim should be to enablethe child to participate in those experienceswhich are uniquely human (Ware, 1994, p.72).Storytelling may be one of these uniquely humanexperiences. Whether it is legend, myth, folktale, fairy story, poem, novel, film or play, theprinciple is the same: everyone everywhere enjoysstories. According to the story Meat of theTongue, we all need them. Angela Carter sug-gests that For most of human history, litera-ture, both fiction and poetry, has been narrated,

not written - heard, not read (Carter, 1991, p.215).

T

Interactivestorytelling:A multidisciplinary plotStorytelling is a uniquely human and social

experience enjoyed by all, including people

with severe and profound learning

disabilities. As such, Keith Parksuggests

it is an ideal vehicle for promoting

multidisciplinary collaboration.

Read this if you believe in the

therapeutic value oflaughter

are seeking ideas forinclusion

want to promotemultidisciplinaryworking




The literature of fiction and poetry from aroundthe world has existed in oral form for many thou-sands of years, long before the development ofcomparatively recent forms: writing, printing,radio, TV, cinema and Internet. The oral narrationof stories was, and often still is, a social eventwhere the story is sung, spoken or chanted, or inother words, performed. Storytelling may be farmore important than reading and writing; our

starting point for literature may therefore be inthe performing of stories.

The reason for the second aim is simply thatmultidisciplinary collaboration can be seen not asa luxury but as a necessity. Interactive storytellingis just one forum that can encourage the devel-opment of multidisciplinary collaboration.Imagine a group of clients with complex needs -children or adults - seated in a semi-circle for astorytelling activity. The speech and languagetherapist may provide the communication aimsfor the activity, the physiotherapist might adviseon the best positioning, an occupational therapistmight advise on the positioning of switches, ateacher of the deaf and an audiologist skilled inthe use of British Sign Language can advise onappropriate sign use, and so on. In theory itseems easy, so we decided to put the theory to thetest.

The day was opened by Alison Keens, theTherapies Team Manager for Lewisham adultswith learning disabilities who welcomed the par-ticipants and explained the aims for the day.

As an introduction to interactive storytelling,everyone then participated in a version of theCinderella story by the brothers Grimm (adaptedfrom Zipes, 1992), a version without the FairyGodmother and Buttons, and with more than ahint of violence. This story is done using three

main ingredients: rhythm, response and repetition.Most of the lines are in eight beat, and this helpsto build a powerful momentum to the story-telling. In almost every case, there is a groupresponse in alternate lines (as indicated in brackets)and so the participants are drawn into the rhythmof the storytelling. Thirdly, there is lots of repeti-tion, which is of course a basic ingredient of folktales where something bad, or good, or different,usually happens on the third visit or the third day.This story is done in pantomime style, and isintended to be colourful, exuberant, and with lotsof participation. Someone is chosen as Cinderellato give direction to the verbal abuse she receives!

It is easier to try it out with your colleagues thanjust to read the words on the page (figure 1).

Easy to doIn this introductory session, several other exam-ples of interactive storytelling were described anddemonstrated (Park, 1998; 1999; 2000). MargaretCharlesworth, a speech and language therapistfrom Nash College, Bromley, gave a presentationon switch use. She brought a variety of switchesand VOCAs (Voice Output Communication Aids),explained their uses, and demonstrated how theycould be used in storytelling and other activities.Pam Davis, from the Intensive Support Resourcebased at Leemore Day Centre then described

some of her innovative storytelling activities at

Figure 1 - Cinderella

Say hello to Cinderella (hello Cinderella!)Cinderellas ugly sisters (Boooo!)They were off to a Three Day Party (Oooooh!)Where the prince might find a bride (Aaaah!)Can I go? said CinderellaThe ugly sisters said:

You cant go cos you cant dance. (You cant go cos you cant dance)You cant go youve got no clothes. (You cant go youve got no clothes)Cinderella went to the hazel tree.She said:Shake and shiver little tree. (Shake and shiver, little tree)Let gold and silver fall on me. (Let gold and silver fall on me)She had a gold and silver dressShe had golden slippers.Cinderella went to the ballCinderella danced with the prince.And then she ran back home (Phew!)

Day two: the sisters got dressed upThey were off to the Three Day Party (Ooooh!)Where the prince might find a bride (Aaaah!)Can I go? said CinderellaThe ugly sisters said:You cant go cos you cant dance. (You cant go cos you cant dance)You cant go youve got no clothes. (You cant go youve got no clothes)Cinderella went to the hazel tree.She said:Shake and shiver little tree. (Shake and shiver, little tree)

Let gold and silver fall on me. (Let gold and silver fall on me)She had a gold and silver dressShe had golden slippers.Cinderella went to the ballCinderella danced with the prince.And then she ran back home (Phew!)

Day three: the sisters got dressed upThey were off to the Three Day Party (Ooooh!)Where the prince might find a bride (Aaaah!)Can I go? said CinderellaThe ugly sisters said:You cant go cos you cant dance. (You cant go cos you cant dance)You cant go youve got no clothes. (You cant go youve got no clothes)Cinderella went to the hazel tree.She said:Shake and shiver little tree. (Shake and shiver, little tree)Let gold and silver fall on me. (Let gold and silver fall on me)She had a gold and silver dressShe had golden slippers.Cinderella went to the ballCinderella danced with the prince.And then she ran back home. (Phew!)But she had lost her slipper! (Oh No! or Oh Yeah? if you want the cynical version!)

The prince picked up the shoe and said:Ill find the girl whose foot fits this shoe,And I will marry her (Aaaahhh!)He came to Cinderellas house.He said: Whose shoe is this?The sisters said its mine its mine. (Oh no it isnt!)Oh yes it is!! (and repeat for as long as you can stand it)

One sister tried the shoe on;Her foots too big, it doesnt fit (Ouch!)Her mother said Cut your toe off (Cut your toe off!)You wont need it when youre queenThe two white pigeons said:Looky look look at the shoe that she took(Looky look look, At the shoe that she took)Theres blood all over. (Yuk!)And the shoes too small. (Ow!)Shes not the bride you met at the ball. (Oooops!)

The other sister tried the shoe on.Her foots too big, it doesnt fit (Ouch!)Her mother said Cut your toe off! (Cut your toe off!)You wont need it when youre queenThe two white pigeons said:Looky look look at the shoe that she took(Looky looky look at the shoe that she took)Theres blood all over. (Yuk!)And the shoes too small (Ow!)Shes not the bride you met at the ball. (Oooops!)

Cinderella tried the shoe on (a long, expectant pause here)The two white pigeons said:Looky look look at the shoe that she took.(Looky looky look at the shoe that she took)The shoes just right.And theres no blood at all.Shes truly the bride you met at the ball. (Yes!!)

So Cinderella married the prince (Hooray!)They lived happily ever after (everyone says the final line together).


8/32

folk song) and figure 3 (a version of Dr Who).Both of these stories are very simple to tell and

were greatly enjoyed by everyone, as were all theothers: an extemporary story about not wantingto get up in the morning, a version of Elmer TheElephant, a send-up of Lewis Carrolls poemJabberwocky, and an adult version of theEnormous Turnip. All of these storytelling activi-ties were very cleverly made, and provide manyopportunities for individuals with the most com-plex needs to participate in the storytellingprocess. They are easier to perform than to read,so try them out - and then, better still, try arrang-ing your own storytelling workshop, and growyour own stories.

Since the workshop, there have been severalstorytelling developments in Lewisham. The sec-ondary school for children with severe learningdisabilities is about to start a regular storytellingproject that will, over the year, involve all of the

pupils at the school, and several professionals



Leemore Day Centre for adults with learning dis-abilities and showed some video to illustratethese sessions. Two main points of all the morn-ing presentations was that, firstly, interactivestorytelling is easy to do, and that, secondly, com-munication devices are essential in encouragingthe participation of those individuals with themost complex needs.

The afternoon session was a practical workshop.Participants divided themselves into groups, tooka story or poem of their choice and had 45 min-utes to re-work it into an interactive storytellingactivity. In the final part of the day each grouppresented their story to the rest of the partici-pants; each story was photocopied and so at theend of the day everyone left with a copy of all thestories for immediate use in their workplace. Twoof the stories that were made that day, in just 45minutes and using no equipment (other than thecommunication aids which would of course be

used in the workplace) are in figure 2 (a Guyanese

Figure 2 - A Guyanese Folk Song

Helena an she muma goh ah grung

What?

Helena an she muma goh ah grung

Ooh!Helena start cry feh she belly

What?

Helena start cry feh she belly

Aah!

Go home HelenaGo home Helena

Go bwoil serose fi yuh belly

Go bwoil serose fi yuh belly

Gal ah wah dis yuh bwoil fi yuh belly

What

Gal ah wah dis yuh bwoil fi yuh belly

Ooh?

Gal ah poison yuh bwoil fi yuh bellyWhat?

Gal ah poison yuh bwoil fi yuh belly

Oh no!

Muma stir de pot

Muma stir de pot

An de nite sage ah cum by di bungle

An de nite sage ah cum by di bungle

De muma she tek some serose

What?

De muma she tek some serose

Ooh!

An she bwoil it an gi it to Helena

What?

An she bwoil it an gi it to Helena

Figure 3 - Dr Who

Look at the Box!What boxThat box thereWhat box whereThat box thereIts the Tardis - oh yeah!

Shall we go inYes well go inShall we go inYes well go in

Whos going in?(name) going inWhos going in?(name) going in

Whos in the boxHes in the boxWho, who?Im doctor WhoWho WhoIm Doctor Who

Were all in the boxClose the doorCountdown commencingOff with a roar5, 4, 3, 2, 1 (everyone stamps feet getting louder and louder)WHOOOSH!

Everyone calls out Dr Who theme music, which of course is as follows:

dum di dum dum di dum, dum di dum dum dumdum di dum dum di dum, dum di dum dum dumdum di dum dum di dum, dum di dum dum dumdum di dum dum di dum, dum di dum dum dumWoo-oooooooooooooooooooooooooooh!!!!!!!

from a number of disciplines. Speech and lan-guage therapists in the adults with learning dis-abilities team are meeting with their colleagues toplan similar activities in a variety of communitysettings. We plan to hold another storytellingworkshop next September to review the activitiesthat have taken place and to plan for futuredevelopments.Keith Park is based at the Sense Family Centre, 86Cleveland Road, Ealing W13 0HE, tel. 0771-502-6354,e-mail: [email protected]. Thecourse interactive storytelling - a multidisciplinary

plot took place at Lewisham Town Hall onSeptember 23, 2000.

ReferencesCarter, A. (ed) (1991) The Virago Book of FairyTales. London: Virago Press.Park, K. (1998) Dickens For All: InclusiveApproaches to Literature and Communication for

People with Severe and Profound Learning

Left: The Guyanese Folk SonggroupBelow: The Dr Who groupBottom: The Elmer theElephant group: Elmer ismulti-coloured, But his friendsare grey.Right: Neptunia - The Goddess

of the Lake group: I commandthe wind to blow!


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Disabilities. The British Journal of SpecialEducation 25 (3) 114-118.Park, K. (1999) Storytelling with people with sen-sory impairments and additional disabilities. TheSLD Experience 23, 13-16.Park, K. (2000) Riverrun and Pricking Thumbs.The SLD Experience 25, 11-13.Ware, J. (1994) The Education of Children withProfound and Multiple Learning Difficulties.London: David Fulton.Zipes, J.(ed) (1992) The Complete Fairy Tales ofthe Brothers Grimm. London: Bantam Books.

SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2001 7


ReflectionsDo I use storytelling as a device

to improve communication and

social skills?

Do I ensure clients have the

necessary communication aids

to enable them to participate?

Are we having fun yet?

See www.speechmag.comfor an example of thisapproach in practice with astudent called Natasha.Humbug, ghosts, partyingand nuts all feature...

news extra..news extra..news extra..news extra..

Preschool music and singing lessonsare proving popular with parentsand children as a means of devel-oping confidence and communi-cation skills.The Jo Jingles franchise startschildren as young as one year oldwith percussion instruments, doing simple action songsand simple music and movement. Between two and threeyears children begin to learn to play the instruments with-out too much help and concepts of loud/ soft and fast/sloware introduced. By three to five years, they often play theinstruments in time to the music and are introduced to sim-

ple music concepts such as duration, orchestral instru-ments, pitch, dynamics and tempo. While packages areavailable for preschool groups such as nurseries, the otherclasses are attended by children with their parents and theemphasis is on informality and fun.www.jojingles.co.uk, tel. 01494 676575.

Childrens brain injury needsImproved links between services for children with acquired brain injury and access to a speech and lan-guage therapist with specific experience are key recommendations of a report into the condition.The Childrens Acquired Brain Injury Interest Group report also focuses on the need to speed up the

implementation of more community-based provision and for accurate information to enable people toaccess services and benefits at the right time. The long-term nature of the impact of acquired brain injuryis emphasised and information for children and young people is described as a specialist skill that can-not be achieved by simplifying material targeted at adults. Many of the recommendations concern theneed to raise awareness and skills among school staff.The Group was established in 1999 as an umbrella organisation to represent and improve the quality oflife of all children with acquired brain injury, their families and carers. One of its goals is to foster collab-oration between health, education and social services.Missing Out - The lifelong impact of childrens acquired brain injury, prepared by Sophie Petit-Zeman,tel. 0115 941 0006 (Secretariat).

New deal for

computersSurplus Jobcentre computers arebeing refurbished by people withcerebral palsy for use within the com-munity.With the Employment Serviceundergoing a modernisation of itsIT, supplier Electronic Data Systemsis giving the old computers to thecharity Paces which aims to create

jobs and training opportunities forpeople with disabilities to help themachieve economic and social inclu-sion. Paces will train disabled NewDealers to recondition the machines

which will then be given to schoolsand charities.Paces was set up in by parents in 1997in support of conductive education forchildren with cerebral palsy.www.paces.org.uk

Training frameworkThe author of a research report into continuing professional development hopes her work will be thecatalyst for multidisciplinary local initiatives.Dr Eve Pringle found that, while there is a broad consensus about its importance, strategic, organisationaland individual barriers remain. The project in Kent and Sussex explored the education and trainingneeds of speech and language therapy, radiography, physiotherapy, occupational therapy, dietetics,chiropody and clinical psychology. The resulting multidisciplinary framework for continuing profes-sional development sets out the need for underpinning structures which facilitate it, better coordina-tion, development of work based opportunities and dissemination of funding information. Trainingfor managers in assessing the needs of their staff and closer working between the professions are alsokey elements.Dr Pringle does not underestimate the difficulties associated with achieving change in attitude andworking patterns established over many years, but notes that by simply creating an opportunity forpractitioners and managers from the separate professions to sit down together and discuss the projectsfindings and CPD issues more generally, ideas began to develop and local initiatives were beginningto be forged.Pushing an open door (A stakeholder approach to developing CPD initiatives for professions allied tomedicine and clinical psychology) by Eve Pringle, ISBN 1901177262, published by the University of

Brighton is 15, tel. 01273 643647.

Communication

skills through music


10/32

Excellent value

HEARING IMPAIRMENT

Guidelines for Mainstream teachers with deafpupils in their class Effective inclusion of deaf pupils into

Mainstream Schools Using residual hearing effectivelyRNIDISBN 0 900634 76 6 ; 0 900634 74 X ; 0 900634 75 85.99 eachThese 3 booklets form part of a series written for educationstaff (mainstream teachers, learning support assistants,Special Educational Needs Coordinators and Teachers of theDeaf) who support deaf children in mainstream schools.

They provide clear, well presented and photocopiablematerial on: different types of hearing loss

strategies for classroom management technology used to support deaf children different communication approaches examples of good practice including sample worksheets,

Individual Education Plans and modified texts.All would be valuable for a specialist speech and lan-

guage therapist working with hearing impaired chil-dren in educational settings. For non-specialists Iwould thoroughly recommend Using Residual HearingEffectively which contains jargon-free and easy to readinformation. The sections on glue ear are suitable forsharing with parents and preschool staff and should beessential reading for anyone working with children.Excellent value.

Rowena Fellingham is a speech and language therapistat a Child Development Centre for Harrogate NHS Trust.

reviews


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

Message does not ring true

SPEECH DIFFICULTIESThe Pebble in the ShoeJohn P. Streicher

Winepress

ISBN 1-57921-266-2 $24.95This book succeeds in drawing attention to theneed to address causes rather than symptomsand in directing therapists to consider theeffects of oral habits (for example, finger orblanket sucking) on physical structure andspeech. However, the authors boastful styleand alleged guidance from God do not inspireconfidence in his many assertions. He statesthat, in order to eliminate most speech prob-lems, an oral habit must be identified and elim-inated and then correct functioning re-condi-tioned and internalised with the help ofthumb-sucking. This message of one universalmethod did not ring true for me.

Admirably, the book seeks to challenge the statusquo, but one is expected to take a great deal on trust.Patricia Sims is a speech and language therapistin North Devon. She specialises in special needs

and literacy problems.

SOMA: Schedule for Oral Motor AssessmentSheena Reilly, David Skuse, Dieter Wolke

Whurr

ISBN 1 86156 134 2 75.00The SOMA has been developed as a standardisedprocedure for the assessment of oral motor skills ininfancy. It is used to identify clinically significantoral motor dysfunction in children with or withoutan identified neurological disorder.

The assessment pack is well presented, and includesdetailed administration and scoring manuals, pub-lished articles, and photocopiable scoring sheets.The background details regarding the developmentof the assessment are interesting and provide rele-vant information about validation and reliability.

The assessment itself aims to rate discrete oralmotor behaviours during the presentation of gradedtextures of food. At first glance the score sheet lookscomplex, but in practice it is relatively easy to com-plete and score. There are a few minor errors in thescore sheet but these should not cause confusion.

At 75 the SOMA is not cheap. However, for ther-apists working in paediatric dysphagia, it is a clini-cally useful tool. With familiarity the schedule can beadministered and scored in around 30 minutes, andthe detailed assessment of specific behaviours witha range of food textures can be helpful in planningintervention and measuring outcomes.Marian Johnson is head of paediatric speech and

language therapy with North Tees and HartlepoolNHS Trust.

Clinically useful

ASSESSMENT

Childrens Speech and Literacy Difficulties (2)Identification and InterventionJoy Stackhouse and Bill Wells

Whurr

ISBN 1 86156 131 8 19.50This book extends the psycholinguistic principles of assess-ment outlined in Book 1. It examines the identification ofspeech processing strengths and weaknesses in childrenand how this can inform the planning and implementationof therapy programmes. The framework can also be usedto measure progress.

It takes a while to read and digest, but it is well worththe time if you are working in paediatrics, particularly inan educational setting. At 19.50 it represents good valuefor money. I certainly now have some new ideas for myown therapy but the more traditional activities can stillbe part of a psycholinguistic programme. The chapter onword finding difficulties was particularly useful but, asthe book indicates, there are many more potential areasof work including dysfluency and intonation.Karen Kelly is a specialist speech and language therapistfor Bournemouth Primary Care Trust working in a sec-

ondary speech and language Base.

New ideas

PSYCHOLINGUISTICS

Introduction to Augmentative &Alternative Communication (2nd Edition)Stephen Von Tetzchner & Harald Martinsen

Whurr

ISBN 1 86156 187 3 29.50A cracking book; relevant to new and experi-enced alike. Prior knowledge is not assumed so itis relevant for a wide variety of readers, not justspeech and language therapists. Clear definitionsand explanations are provided throughout. It ispractical but thought provoking and takes youthrough the whole process of providing an AACsystem for an individual from describing anddefining low and high tech AAC (eg. manual andgraphic sign systems; voice output devices)

through to the choice and implementation of thesystem. It also discusses the role of the conversa-tion partner, and conversation skills of the user.

Its focus is on potential AAC users withdevelopmental language and communicationdisorders only, and it provides information onthe most common groups (eg. motor impair-ment and autism.)

One criticism: it is unclear as to which manualsign system is being depicted throughout thebook, which may be a little confusing forthose less familiar with particular systems.

Excellent value for money!Penny Williams is a speech and language ther-

apist at John Chilton School (a schoolfor children with physical & medical needs.)

A cracking book

AAC

Voice and SelfIngeburg Stengel & Theo Strauch

Free Association Books

ISBN 1 85343 500 7 15.95This book looks at integrating and developingeach individuals vocal potential and identity.Allowing the client control of their therapy, itlooks at the relationship between vocal functionand personality. It explores this relationship,encouraging the therapist and client toacknowledge the link to achieve optimum voice.

The chapter on anatomical and physiological linksin voice production could be a useful resourceto share with the voice client. Very detailedexercises and their implementation follow.

Overall, a useful book for the therapist start-ing out in the field of voice, stressing, as itdoes, the importance of bringing togethervoice and self. The more experienced therapistwill find old favourites as well as new vocal andphysical exercises to add to their repertoire.Mary Price is a specialist speech and language

therapist working for NHS Tayside.

Detailed exercises

VOICE



reviews

Comprehensive,effective, time effi-

CHILD LANGUAGE

As Long As Possible: AnEncounter with Motor NeuroneDiseaseLinda Mowatt (proceeds to

MNDA/Sir Michael Sobell Househospice charity)

Quince, Oxford

ISBN 0-9539228-0-4 9.99This is hard to start reading because itis not an academic, or How to ..book, and is not going to be a com-fortable holiday novel - so why read it?

Billed as a love story, there are somedelicate and poignant glimpses of theindividuals beneath the text, but thepassion is subsumed by the increasinglycomplicated and protracted practical-ities of everyday life with a severe dis-ability. It is a largely matter of fact

account of the authors journey, withher lover, through the progression ofhis motor neurone disease, a journeythat is harrowing but, for her, aninevitable choice.

It is valuable for students and forthose new to progressive neurologicaldisorders as a personalised case history.It catalogues the progression of symptomsand services on offer, the use, or not,of communication aids, IT and otherequipment, and the rejection or accep-tance of help. It does not dictate orpretend to be a definitive account.

Instead, it challenges us to reflectmore carefully on issues such as resis-tance, over-protection and potentiallyabusive relationships. Clinicians at alllevels will find it useful to use parts totrigger discussion and reflection onissues we encounter daily. It could,also, inform our process of assessment,decision making and goal setting, as ithighlights how important the personalrelationship and knowledge of thehome situation is for clinicians.

Most importantly, perhaps, anyonewho works with people facingincreasing difficulty and loss of com-munication cannot help but betouched by the grief (plus all the otheremotions) that that person and theirfamily and friends are suffering. Thisbook will remind the experiencedamong us and warn the inexperi-enced that supervision, reflecting onour own views of loss and disability,and finding a way of managing ourown grief are essential for our workand health.Gwyneth Evans-Patel is a specialist

speech and language therapist withCroydon and Surrey Downs

Community NHS Trust.

Useful for discussionand reflection

PROGRESSIVE NEURO

CELF-3UK

The Psychological Corporation345.20The CELF-3UK is a comprehensive

assessment tool which displays thepotential to provide valuable informa-tion in the diagnosis and interventionof communication skills across variousindividuals, including people withlearning disabilities. This colourfuland attractive test is standardised andrepresentative to the UK population.It examines various communicationskills using a combination of core andsupplementary subtests which can beanalysed and used for: screening assessment/qualification for

service/placement

extension testing establishing objectives and

interventions assessment progression.

The CELF-3UK displays political termi-nology when referring to age groups(children, adolescents and youngadults) and has attempted to reduceany bias of race/ethnicity, gender andability/disability.

Formatting of the Record Form pro-vides accessible verbal scripts requiredby the examiner in many of the subtestsand an accessible and easy scoring

format, whereby quick addition ofthe raw scores can be establishedafter each subtest. Additionally, thestarting point and discontinuationrules are clearly outlined on theRecord Form and have the potentialto avoid frustration and wasting oftime during testing.

Initially the CELF-3UK can be quite timeconsuming but - once the examiner isconfident and experienced in theadministration, scoring and interpre-tation of all the subtests within thevarious age groups - it has the potentialto be a comprehensive, effective andtime efficient assessment tool.

Difficulties may arise when using itwith people who have a learning dis-ability. This client group may find thesubtle clues difficult to detect.However, the stimulus manuals providea variety of materials upon whichassessment and intervention can bebased for this population.Helen Aguirre is a speech and lan-guage therapist with LifespanHealthcare in Cambridge. She wonthis assessment in the Autumn 2000issue of Speech & Language Therapy

in Practice.

..news extra..news extra..news

Valuing peopleA major new strategy aims to improve radically the life chances of peoplewith learning disabilities in England.The principles of civil rights, independence, choice and inclusion are behind

key initiatives in the Governments white paper which was developed inconsultation with people with learning disabilities. Designed to tacklethe social exclusion and discrimination experienced by many people withlearning disabilities and their families, the strategy will affect the work ofmany agencies - social services, health, education, housing, employment,the Benefits Agency, and the independent and voluntary sectors.The key initiatives include a new fund of up to 100m over the next twoyears, improvements in community accommodation, council day servicesand advocacy services, the creation of a Task Force, more research andspecialist local services for people with severe challenging behaviour.Valuing People: A new strategy for learning disability for the 21stCentury is at www.doh.gov.uk/learningdisabilities (or 15.95 from TheStationery Office.)

AAC shiftThe concept of personal equipment marks a shift in government attitude tocommunication aids in England that has been welcomed by a disability charity.Schools Minister Jacqui Smith has announced 10m to provide hi-techcommunication aids to children with special educational needs and dis-abilities and back this up with appropriate training for teachers and users.Working with specialist centres and the voluntary sector, she says that Aswell as helping young people to access the curriculum and learn alongsidetheir peers, this project will aim to ease their transition from school intoemployment or further or higher education. In some cases this may meanthat a particular piece of equipment goes with the young person, and the

concept of personal equipment will be at the heart of this work.The announcement follows a visit by communication aid users NikolaRennie and Jenna Jones, who attend Scopes Beaumont College inLancaster, to the House of Commons. They helped launch a Scope reportwhich showed some people were being denied a voice, with funding forcommunication aids a postcode lottery dependent on the policies of edu-cation, social services and health authorities.Speak for Yourself from Scope, 3 for individuals and aid users, 12.50 to

professionals and organisations, tel. 020 7619 7341.

Free personal

care in dementiaA dementia charity has welcomed the Scottish Executives commitment tolegislate for free personal and nursing care for people with dementia.Legislation is to be introduced by 2002 which will enable people withdementia and other chronic illnesses in Scotland to receive free nursingand personal care on the basis of assessed need. However, AlzheimerScotland - Action on Dementia has also called for immediate action toend postcode prescribing of dementia drugs in Scotland now that theNational Institute of Clinical Excellence has ended the practice inEngland.

Alzheimer Scotland - Action on Dementia, tel. 0131 243 1453, telephonehelpline 0808 808 3000, www.alzscot.org(The Editor apologises for putting an incorrect website address in the last

issue of Speech & Language Therapy in Practice.)


12/32

cover story


he Spotlights on LanguageCommunication System [SPOTS-ON]has gradually developed over a 16-year period to meet the functional

needs of giving and receiving mes-sages. It was first used to assist dysphasic adultclients and then children with mild learning diffi-culties and language impairments. The ideabehind the Spotlight stems from using differentcoloured beams in a special torchlight as if it werea spotlight on part of a scene in a theatre, butinstead used on pictures or actions. Central to theapproach is the use of basic shapes (figure 1).

For the adults, shape outlines only were dis-played on a page in which information could becollated, for example; who was referred to? whatwere they doing? where were they? For the chil-dren, the shapes in a line on a page were used asa clue to organise their memories into verbal com-munication. The instruction for 10-12 year oldswas to think of pictures in your mind and relaythem by drawing and / or using spoken words. Thetorch proved too interesting to the children, sothey were provided with something to hold thatwas relevant to the task.

For several years the system has been furthermodified for use with 4-7 year olds within a schoolfor children who have speech, language and com-munication impairments, some of whom may havecharacteristics associated with the autistic spec-trum. This has involved making use of the knowl-edge gained from the work of authors in differentdisciplines to devise, support or confirm aspects in

the system.

T

Read this if you work with anyone with

language impairment want to bridge the gap

between the non-verbal and the verbal

like to use a flexible,individually responsiveapproach

In 1984, Carole Kaldordevised a multisensoryapproach to language intervention, now known as

the Spotlights on Language Communication System.Although it has been modified for children withvarious difficulties, it was initially used to meet the

functional communication needs of adults withdysphasia. Here, Carole and her colleagues,

Janet Tannerand Pat Robinson, highlight itsbenefits and applications. Although they focus on

children with specific language impairment, the

principles and methods are just as relevant for adultneurological and adult learning disability client groups.


13/32

for the child to draw or write their word withinthe outline. The outlines for a sentence or phraseindicate the number of different elements thatmake up the verbal utterance. It is not expected in

the early stages that a child will be able to recall orwork on the whole of the utterance and its mor-phemes (figure 3). From the adults knowledge ofthe childs abilities, it is possible to indicate in anon-verbal way the number of elements he shouldattempt, and Paget Gorman Signing supports thewords and the grammatical morphemes. Thechilds holophrases can be set out in the elementsof a sentence so they can begin to see the separatewords, or that their words may be combined.

The materials provide links for thequestion/answer situation in a social settingwhere the answers are unknown. The question isformed initially so that the answer is in the pictureand therefore easily accessible.

The activities involved in the SPOTS-ON systemare also designed to assist a child in understandingthe passing of time in a repeating weekly cycle.Within the week events are also linked so, forexample, on Thursday we revisit Wednesdays playactivities as together we watch the video of themat play. This also provides the child with an oppor-tunity to see their moving image and relate theaction to a verbal label. These are just examples ofwhat we do in class 1, and users of the systemshould make use of the materials, at a level of pre-sentation appropriate to their particular client.Further, the life in the shared communicationbetween therapist and client benefits from the

therapist thinking up their own activities.

SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2001 11

cover story

ResponsiveAims are within an overall approach that isresponsive to the child from moment to moment,and therefore highly flexible in its rules. In general,

the system aims to: make it possible for children with specificlanguage impairment to make use of theirvarious and successful modes of communicationand of their creativity

and encourage the children to use their memory,

mainly through their five senses - and especiallythrough their actions and sense of touch.

More specifically, it aims to enable young children to become proficient in

understanding and using verbal language in itsearly stages of development for their ownthinking, learning and communication

provide a link between their process of pre-verbalthinking - which is highly personal and can bepictorially based - and adult verbal languageused around them

provide a consistent method to help childrenbecome aware of verbal language structures asa means of communication.

These colours to indicate different linguistic infor-mation (figure 2) were developed by Philip Conn(1973) and, because this was the system used atMeath School in 1988/9, these colours have beensuperimposed onto the shapes. The colouredshapes are presented in three forms: see-throughacetate; card; outlines. The different colouredacetate shapes are used as hand-held overlays to

act as spotlights. These can capture a childs invol-

untary visual attention to create a potentialshared focus. The focus could be an actual objector action, a pictured event or, later, written lan-guage. The acetates can be used anywhere as

spotlights; for example, a yellow circlea) held over a childs hand as they stir cake mix-ture so they focus on their actionb) used as an overlay on part of a childs drawing,orc) on a video of the child at play.

The overlay can be used to create a sense ofanticipation and the use of a specific colouredshape can provide a clue for the child to mapmeaning onto a visual scene. The colouredacetate shapes provide a primary linking device inthe system, making it possible to make connec-tions between the event and the verbal language.

Concrete and practicalThe coloured card shapes are used in tasks toassemble (construct) the verbal message in a linearform from left to right. They also act as a clue,when the card is blank, that information is neededfor the formation of their verbal utterance. Thisinformation can be supplied by using an actualobject stuck onto the card, a symbol, a photo, adrawing or the written word. In this way, the childcan practise abstract verbal tasks in highly concreteand practical ways using the words on the differentcard-shapes.

Outlines of the shapes can be drawn withcoloured pencils as non-verbal clues indicating tothe child where on the paper to place or stick the

words. A further stage in the process could be

Figure 2 SPOTS-ON colours (after Conn, 1973)

pink for a name

orange for a label

yellow for an action

blue for a preposition (place)

green for an attribute.

Figure 1 - SPOTS-ON shapes

There are three basic shapes for giving clues tolanguage structures

triangle

names, labels,pronouns (thesubject); andattribute ornumber (anadjective)

circle

actions (theverb)

arrow

places (theprepositionalphrase oflocation)

Figure 3 - modifications of basic shapes

These basic shapes can be modified - if and when appropriate for your aims - to representelements in language, for example:

small triangle(such as forplural)

1/4 of a circle(such as foris)

1/4 of a circle(for -ing)

verb +morpheme =verb...ing

folded circle =simple pasttense

Left: A child draws herself and her birthday cake. Although she speaks

mainly in single words, using SPOTS-ON we can produce a sentence

together - I have 6 candles on my birthday cake.See back page for colour illustration of this and other photographs.


14/32

cover story


From the childs own impetus, through theadults responses, communication is established.Together they work towards sharing a verbalworld. The work of Lowenfeld and Winnicott andothers in early infant and childhood development

has confirmed and informed the approach, espe-cially in the early tasks of SPOTS-ON. The childrenhave a tenuous connection with our communica-tions and our language system so we need to beflexible in our responses in order to keep life con-tinuously linked together and meaningful for thechildren. Initial interaction may be of very shortduration.

ReadinessGoleman (1996) refers to readiness for schoolwhich he says depends on the most basic of allknowledge, how to learn. He quotes a reportfrom the National Center for Clinical InfantPrograms and lists seven key ingredients of this

crucial capacity. They are:1. confidence2. curiosity3. intentionality4. self-control5. relatedness6. capacity to communicate7. co-operativeness.In our management and general approach weaccept these ingredients are vital if the childwith speech and language impairment is to accessour curriculum. As staff we all acknowledge all ofthe time, as others do, that the children need todevelop this school readiness and reach the emo-

tional maturity that will help make the curriculumaccessible to them.SPOTS-ON has two key phases:I. Noticing words (pre-verbal to verbal experi-ences)II. Using words (combining, slicing and dicing).

I. Noticing wordsTrevarthen (1993) states that emotions... are nec-essary in the process of qualifying, creating andconnecting meanings. Lowenfeld (1934) discuss-es the emotions, which lie behind any successfuleducation. Among the emotions she suggestsare curiosity the desire for power...and control (in the sense of

mastery of self and of all that surrounds the child) an interest in sensuous experience (by which

she refers to an interest in and understandingof sensorial experience, processing that whichcomes through the five senses, and throughthis, the relationship with the environment)

a desire to be looked at (and every child passesthrough a stage where they might be sayingwatch me, look, I can do this).The SPOTS-ON approach attempts to incorpo-

rate recognition of these areas for development.Curiosity is key. We work on building it and thenhope to facilitate the childs own creativity, curios-

ity and responsibility in the learning process. So,

the importance of a childs multisensory experi-ence, actions and, in particular, the sense of touch

and movement, useful to the child at their stagein development, are acknowledged by visiting anadventure playground. During the sequence oftasks, we give the children materials to touch -objects sent in from home as a reminder of eventsat the weekend. Power is given to the child intheir efforts to find the power of words throughtheir creativity. The desire to be looked at is satis-fied in the one-to-one sessions and video viewingof each child at play.

Lowenfeld includes in her hypothesis on emo-tional development that A child thinks with hishands. Therese Woodcock (tutor, Lowenfeld pro-

ject) suggests that the child touching their

words as they assemble them may be an impor-tant factor in their engagement in the task.Actual objects may be used to represent a word;for example, the train ticket from a recent jour-ney stuck onto the relevant noun triangle.

Spensley (1995), referring to children with autism,writes of a disjunction of looking and listening.She believes that these are the two principlereceptive modes, which, coming together, producethe big bang of recognition and response. Keenet al (2000) refer to impairments in the use of eyegaze in children with autism, and difficulties inthe scenario where pointing is a communicativeact. These matters are addressed using the see-through acetate in an attempt to gain attention -perhaps holding it at eye level to capture gaze -and lead on to shared communication.

In the individual tasks of SPOTS-ON, the adultsneed to sit and listen to the children one-to-oneas they communicate about the pictures they arecreating. This provides the notion that listeningexists. The preparation of the childs picture, theirrecord of experience, is all-important in the effortto reach words. It is possible that the experienceof the childs involvement in creating their ownvisual memory of an event (a picture) triggerstheir own words. It has meaning to them. The pic-ture is a memory of their multisensory experience,transformed in the process of producing their

own drawing.

In using SPOTS-ON with children, it has beennoted in more than one childs effort that the

memory of their own movement often appears tohave been the motivation for their drawing. Onechild returned to class with the wooden spoon hehad used in cooking and spontaneously produceda picture resembling a circle scribble - his picture ofstirring. He first touched the relevant objectwhich aided his memories of it. He provided a visualrecord of the action in memory, and the drawingthen provided the focus for verbal communicationto take place. In the subsequent task, the childused his sense of touch to assemble the sentence.

II. Using wordsOnce the child has begun to make links from his

idiosyncratic, pre-verbal world across into oursocial, verbal world, work on combining wordsand slicing and dicing (Tomasello & Brooks,1999) language can begin in earnest. SPOTS-ONprovides the language-impaired child with helpto analyse and synthesise language from the firstwords and holophrases to complex spoken orsigned utterances, including the morphemes and,later, written sentences.

Starting as SPOTS-ON does with the childs impe-tus, it is possible to share the scene from thechilds viewpoint. The materials with symbols orwords on are used to create shared referencepoints. The scene can then be shared from differ-ent viewpoints, at first on separate occasions.

The Construction Grammar approach, as out-lined by Tomasello & Brooks, moves from thisanalysis of scenes and describes a developmentalprocess in which the child uses specific and con-crete linguistic phrases to partition their scenes.With practice and experience children are able togeneralise discovered patterns in novel utter-ances. It is believed that the SPOTS-ON systemprovides the extra multisensory support and cluesthat speech and language impaired children needto discover for themselves the patterns in verballanguage and then to make their own use of thisknowledge in communication. The aim is that ver-bal language becomes the childs preferred and

spontaneous means of communication.

Curiosity is key.

We work on

building it and

then hope to

facilitate the childsown creativity,

curiosity and

responsibility in

the learning

process.



cover story

Future focusThere are three main avenues to explore fur-ther when using the SPOTS-ON approachwith our children:1) The Verb Island Theory

2) Discovery, creativity and play3) School readiness and the NationalCurriculum.

1) The Verb Island TheoryThis theory may have some impact uponthe current linear order, left to right, inwhich we present SPOTS-ON to the chil-dren. As soon as the child shows interestin his actions, is it better to first presentthe verb on the page and then work onwhat comes before and after it?Lowenfelds view on personal experience - prever-bally - is that all in an event is fused together.

Children have often focused on their own move-ment in producing a drawing, perhaps beginningto tease apart this fusion in memory. These factorsmay suggest reaching the linear form of languagethrough the verb first.

2) Discovery, creativity and playTomasello & Brooks (1999) refer to the child needingto discover the syntactically relevant semanticfeatures of the verb. They also refer to the factthat the childs own generalisations across verbsin creating constructions is a central question inthe study of childrens syntactic development. Itis in the nature of play that you are discovering and

creating. In play, a child is also thinking, reasoning,problem solving and organising. Lowenfeld (1991)states that play is to a child, work, thought, art, andrelaxation, and cannot be pressed into any singleformula. It expresses a childs relation to himselfand his environment, and, without adequateopportunity for play, normal and satisfactory emo-tional development is not possible. Winnicott(1974) states that it is in playing and only in playingthat the individual.., is able to be creative.Perhaps these acts of creativity and discovery inone mode, play, can be transferred to another:discovering and creating verbal language. This maysuggest more activities where the childs multisensory

play actions are the focus.

3) School readiness and the National

CurriculumAt the same time as attempting to make good useof the National Curriculum for school-aged children,we also often need to respond to a child whoseemotional maturity does not yet fully meetdescriptions for school-readiness. This is not to saythat school readiness is not within the childrensgrasp, especially if we concentrate further onthose ingredients related to emotional intelli-gence and referred to by Goleman (1996),Lowenfelds thoughts on successful education,

and Trevarthens ideas of creating and connect-

ing meanings. Another aspectto investigate further would beWinnicotts description of thecapacity to be alone in the pres-ence of another (1990) which

presumably, if developed suffi-ciently, could make it moreswiftly possible for a child toparticipate in classroom activitysince, in the classroom, one isrequired constantly to workalone in the presence of othersand then to slide fromabsorbed individual thoughtback into receiving mode inorder to listen.

Carole Kaldor is a speech and language therapistat I CANs Meath School in Surrey, e-mail

[email protected], [email protected], tel. 01932 872302. PatRobinson is the Curriculum and AssessmentLeader at Meath. Janet Tanner, formerly a speechand language therapist at Meath, is nowemployed by Portsmouth City Primary Care Trust,e-mail [email protected], tel. 01329 828706.

AcknowledgementsThanks are given for the support and advice inpreparing this paper to: Therese Woodcock; AnnFarquhar, Head of Speech and Language TherapyService and staff involved at Meath School, andthose working in Class 1 (Toni Beynon, Linda

Daniel, Melanie Hanks, Jeannie Kent, MaureenLaidlaw, Maureen Rymill, Karen Davis). Graphicsby Sheila Shanks. Special thanks to the children inClass 1 for their work. Also thanks to Pat LePrvost, then Head of Services for LearningDisability in Oxfordshire, for inspiring me with hermanagement strategy with a group of 18 monthold children in 1980.

ReferencesConn, P. (1973) Language Therapy. London:Invalid Childrens Aid Association.Goleman, D. (1996) Emotional Intelligence, 193-4.London: Bloomsbury.Kaldor, C. (1999) unpublished presentation, AfasicConference, York.Keen, D., Sigafoos, J. & Woodyat, G. (2000)Functional Communication Training andPrelinguistic Communication Behaviour ofChildren With Autism. Advances in Speech &Language Pathology2, 107-117.Lowenfeld, M. (1934) What is meant by emotion-al development? Parents and Children 1 (1) Jan.London: New Era.Lowenfeld, M. (1991) Play in Childhood, 232.London: Mac Keith Press.Spensley, S. (1995) Frances Tustin, 125. London:Routledge.Tomasello, M. & Brooks, P.J. (1999) Early syntactic

development: A Construction Grammar approach.

In Barrett, M. (ed) The Development of Language,161-190. Hove: Psychology Press.Tomasello, M. (2000) Acquiring Syntax is not whatyou think. In Bishop, D.V.M & Leonard, L.B. (ed)Speech and Language Impairments in Children, 1-

15. Hove: Psychology Press.Trevarthen, C. (1993) Playing into reality.Winnicott Studies 7, 67-84. London: Kamac.Winnicott, D.W. (1974) Playing and Reality, 63.Middlesex: Pelican.Winnicott, D.W. (1990) The Maturational Processesand the Facilitating Environment, 29-36. London:Karnac Books.

Resources1. Carole Kaldor and Pat Robinson are planning a

workshop on the SPOTS-ON system. Detailsfrom I CAN, e-mail: [email protected],tel. 0870 010 7088.

2. John Lea (1970) The Colour Pattern Scheme - AMethod of RemedialLanguage Teachingfrom Moor HouseSchool, Oxted, Surrey.

3. The LowenfeldProjective PlayTherapy part-timeMSc program is run

jointly by The Dr.Margaret LowenfeldTrust and MiddlesexUniversity. For aprospectus, contactSue Barnard,

52 Barton Road,Haslingfield,Cambridge CB3 7LL,tel. 01223 872291.For furtherinformation, contactSusie Summers,Course Coordinatorand speech andlanguage therapist,tel. 0207 267 7439.

4. Paget GormanSigned Speech(1994) - Detailsfrom Paget GormanSociety, 2 DowlandsBungalows,Dowlands Lane,Smallfield, SurreyRH6 9SD.

5. Transparent paper in many colours from LeeFilters, Central Way, Walworth Industrial Estate,Andover, Hampshire SP10 5AN, tel. 01264366245, fax 01264 355058,e-mail [email protected].

6. The Squiggle Foundation exists to study andcultivate the tradition of D. W. Winnicott F.R.C.P.Administrator: 33 Amberley Road,London N13 4BH,

tel. 0208 882 9744, fax 0208 886 2418.

Reflections Do I base

language work

on actions

and sensory

experience to

build memory?

Do I make

sufficient use

of video as amethod of

reinforcing

learning?

Do I have

methods for

capturing the

dynamic

nature of

language,

particularlyverbs?

adults need to sit

and listen to the

children one-to-

one as they

communicateabout the pictures

they are creating.

This provides the

notion that

listening exists.


16/32

in my experience


Or, as Giddens (1986, p.2) points out, sociologydoes not come neatly gift wrapped.

Sociology is concerned with both social structureand social action. Theories of social structure areconcerned with the way in which social and eco-nomic structures influence social behaviour.Examples of these macro-sociological theories

include functionalism, Marxism and, to someextent, feminism. In contrast, theories of socialaction are concerned with the way in which indi-viduals can help to shape society. An example of

this approach is symbolic interaction-ism, a micro-sociological theory. Eachof these theories are correct inthemselves, although not in relationto each other. This is why sociology isdescribed as multiparadigmatic.

Deeper understandingIn 1959, C. Wright Mills coined thenow well-known phrase, the socio-logical imagination. This is a goodway to understand sociology, as itrefers to the way in which sociolo-gists question familiar expectations

and assumptions (Cooke, 1993), taking the every-day and the taken-for-granted and lookingbeyond obvious explanations to gain a deeperunderstanding of contemporary social issues. Thesociological imagination also refers to the way inwhich the personal is seen to be influenced by thesocial, the political and the economic. Mills (1959)explains this with reference to what he calls pri-vate troubles and public issues. For example,stammering is both a private problem for theindividual and a public issue because of the dis-

abling attitudes of society towards people with

ithin everyday practice,speech and language thera-pists deal with individualcommunication difficulties.However, to assess, treat and

prevent such difficulties it is important for thetherapist to appreciate the wider social structures

and the social processes which influence the abili-ty of each client to deal with his or her difficulty.One of Sure Starts six key targets is the improve-ment of childrens speech and language; as part ofthe Governments social exclusionprogramme it recognises the relation-ship between poverty, deprivationand communication problems inyoung children and later life(Sheridan, 1999).

Although the study of sociology hasbeen explored in the context of otherhealth professions such as nursing (forexample, Cooke, 1993), my experienceof teaching speech and languagetherapy students has prompted me toreflect on the role of sociology intheir education. Becoming a speechand language therapist does not solely concernthe acquisition of clinical knowledge and the testof clinical competence; the adoption of a holisticapproach marks a shift towards a more humanis-tic concern with communication. Within this shift,sociology should be seen as central in enablingthe therapist to deal with the whole client.

The question But what is sociology? is notori-ously difficult because there is no one answer.Sociology is multiparadigmatic; it consists of avariety of competing paradigms (Kuhn, 1962)

which exist to explain any number of phenomena.

But why do we have

to do sociology? - This

lament may be familiar

to those involved in

teaching the subject,

but Sarah Earle argues

that sociology is

essential if students are

to become reflective

practitioners with an

appreciation of the

value of research and

an understanding

that successful

communication is

influenced by social

factors and access

to services.

W

Read this if you want to take a holistic

approach believe the profession

needs a strongerresearch

base could develop your

sociology should

be seen as

central in

enabling the

therapist to deal

with the wholeclient

Sociology:a sure

start


17/32

communication difficulties.Thus, by engaging with sociol-ogy and developing a socio-logical imagination, studentscan learn to understand and

make better sense of society.Sociology comprises of a

range of competing para-digms which enable us tomake sense of the social world. However, whilstthere is no one dominant theoretical paradigm toprovide a blueprint for understanding socialbehaviour, sociology does help us to see the indi-vidual within their wider social context. Thedevelopment of a sociological imaginationenables us to consider the ways in which personalissues are influenced by social, economic andpolitical factors. This is an important aspect ofholistic therapy, fundamental to the care of clientswith communication difficulties.

The classic sociological study of suicide conduct-ed by Emile Durkheim in 1897, is an example ofthe way sociology can demonstrate that the per-sonal is political. Suicide is one of the most appar-ently individual and personal of acts; however, byusing quantitative official statistics, Durkheimdemonstrated a positive correlation betweenhigh suicide rates and indicators of low socialintegration, such as living in urban areas andbeing unmarried. He argues (1979, p.47),

If...the suicides committed in a given societyduring a given period of time are taken as awhole, it appears that this total is not simply a

sum of independent units, a collective total, but

is itself a new fact sui generis, with its own unity,individuality and consequently its own nature -a nature, furthermore, dominantly social.Durkheims overall conclusion is that an under-

standing of suicide can be achieved without ref-erence to the individual motivations of peoplewho have committed suicide. For Durkheim, andother sociologists like him, social structure acts asa determinant of human thought and activity(Billington et al, 1998, p.18).

Implicit reflexivityThe multi-paradigmatic nature of sociology createsan inherent reflexivity within the discipline whichentails a continual reflection on its own grounds(Sharp, 1994, p.394). Although by no means con-sensual, the past few years has seen a shifttowards a more reflective practice within speechand language therapy whereby therapists areencouraged to question the validity of therapies(Enderby & Emerson, 1996) and have acknowledgedthe more tacit aspects of dealing with commu-nication difficulties (Mobley, 2000). The implicitreflexivity within sociology can inspire speech andlanguage therapists to question commonly heldassumptions about their everyday practice.

Evidence-based practice is becoming increasing-ly significant within speech and language therapy.The Position Statement on research and develop-

ment in the therapies stresses the increasing role

of research as a means of improv-ing the nations health and qualityof life (DoH 1995, p.1). However,whilst newly qualified studentswill have some basic grounding in

research skills, the professionsrecognise the importance ofdeveloping a much strongerresearch base, arguing that,

Therapists, like nurses, are in the best position togenerate their own research questions and toinvestigate their own practice...This early exposureto research aims to foster critical consumers ofresearch who are capable of evaluating their own

practices against reliable up to date evidence.(DoH, 1995, p.4)The study of sociology makes a unique contribution

to evidence-based practice in two distinct ways.Firstly, it provides the speech and language ther-

apist with a wealth of both qualitative and quan-titative methodologies with which to conductresearch, enabling them to formulate researchquestions and investigate their own practice. AsMobley (2000) has suggested, speech and lan-guage therapists have traditionally employed avery limited range of methodologies, many ofwhich are not wholly suited to the study of adultsand children with communication difficulties (seealso Code, 2000 and Greener et al, 2000). The studyof sociology and sociological research methods canbe used to help speech and language therapy stu-dents understand and interpret research findings.

Secondly, sociology provides the therapist with abroad range of research findings that can be applied

to the needs of speech and language therapy. Thecollection of empirical data can be used to makemore rational judgements about practical issues, asignificant aspect of evidence-based practice.Empirical data can also be used to make reasonablepredictions; this can be helpful in the planningand delivery of therapy services. In addition, it ispossible to use empirical data to explain socialphenomena; that is, to subsume statementsabout them under more general statements(Bottomore, 1962, p.55). This, too, is helpful as itenables speech and language therapists to under-stand their clients needs more holistically andwithin a wider socio-economic framework.

Sociology therefore contributes in three funda-mental ways to the education of speech and lan-guage therapy students:1. it helps students understand that successful

communication is influenced by wider socialfactors such as gender, age, ethnicity and(dis)ability, as well as by differences in access tohealth care services;

2. its multi-paradigmatic and inherently reflexivenature encourages students to recognise thetacit nature of their practice, thus allowingthem to become more effective, reflectivepractitioners;

3. it assists students to understand and engage inresearch; a transferable skill that they will find

invaluable throughout their working lives.

Dr Sarah Earle is Lecturer in Health Studies atUniversity College Northampton. Address forCorrespondence: Centre for HealthcareEducation, Boughton Green Road, Northampton,NN2 7AL, e-mail: [email protected],

tel. 01604 735 500.

AcknowledgementsI would like to thank Mike Filby, who encouragedme to write this article, Oonagh Reilly and AngelaHurd for their encouragement; and the speechand language therapy students at the Universityof Central England, Birmingham.

ReferencesBillington, R., Hockey, J. and Strawbridge, S.(1998) Exploring Self and Society. London:Macmillan.Bottomore, T.B.(1962) Sociology:a guide to prob-lems and litera-ture. London:Unwin UniversityBooks.Code, C. (2000)The problemwith RCTs. RCSLTBulletin March(574) 14-15.Cooke, H. (1993)Why teach soci-ology? NurseEducation Today

13 (3) 210-217.DoH (1995)Research &Development inO c c u p a t i o n a lT h e r a p y ,Physiotherapy and Speech and LanguageTherapy: A Position Statement. London: DoH.Durkheim,

Speech & Language Therapy in Practice, Summer 2001

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