speech & language therapy in practice, winter 1997
TRANSCRIPT
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 1/32
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 2/32
The bigbreakthroug hon a smallscale
T
he new DynaMyte is a lightweight,
capabilities which introduces a new dimension to
augmentative communication by offering greater
freedom to the ambulant user.
advanced communication capabilities, and uses the same software . A built- in
remote control unit allows the user to
access computers and other household appliances, and it
portable device with powerful communication
DynaMyte is just half the size of DynaVox 2 and yet it retains all its
The DynaVo x 2features a system of alarms capable of performing a varietyugmentative
communication aid of preset tasks. A clear, easy to operate touch displayhas introduced 0 provides access to the full range of DynaMyte'snew era of freedom to
communication power. Its long life battery and durable,eople of all ages whohave speech disabilities. rubberised casing guarantees easy to carry communication
fo r people of all ages with speech disabilities.
DynaMyte is a natural product extension from the
advanced DynaVox 2 communication device which
successfully enables many users with mobility impairment to
develop a greater sense of self expression and
independence .
For full information and demonstration, contactDYNAMICDYNAMIC ABILITIES LTDA ~IM IT E D THE COACH HOUSE, 134 PUREWELL
CHRISTCHURCH,DORSET
BH23 1EU
TELEPHONE: 01202 481818~ ~ FAX: 01 202 476688
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 3/32
CO N T E ~ N ~ T S i i i i E F lWinter 1997
(publication date 24th November)
ISSN 1368-2105
Published by:
Avril Nicoll
Lynwood Cottage
High Street
Drumlithie
Stonehaven
AB393YZ
Tel/fax 01569 740348
e-mail [email protected]
Production:
Fiona ReidFiona Reid Design
Straitbraes Farm
St. Cyrus
Montrose
Printing:
Manor Group Ltd
Unit 7, Edison Road
Highfield Industrial Estate
Hampden Park
Eastbourne
East Sussex BN23 6PT.
Editor:
Avril Nicoll RegMRCSLT
Subscriptions and advertising:
Tel I fax 01569 740348
©A vril Nicoll 1997
Contents of Speech & Language
Therapy in Proctice reflect the views
of the individual authors and not
necessarily the views of the publish-
er. Publication of advertisements is
not an endorsement of the adver-
tiser or product or ser vice offered.
Cover pictLlre:Auditory sequentialmemory by Maggie Johnson
News/
Comment
4ActivatingPotentialforCommunication
,; ,---. . ...... - . . ,deficits have a particuSpeech and language
and occupationaltherapy staffoutline the benefitsof a packagedprogramme for theelderly.
Counselling NLP 9Studying Neuro LinguisticProgramming has made asignificant impact on the way
Caroline Skelton works as aspeech and language therapist.She explains how.
Special Debbie Wilcox ,Sarah-Janefeature - clinicalBurns andAnitaMdadzean
In two reports, Ann Parker
teaching 13
who rundescribes group placements early
in pre-school centres with communicationKeena Cummins, then for adults groups list the tenwith a learning disability with resources they could notSarah Farazmand. do without.
218
COVER STORYAuditory segu.entialmemory defiCitsMemory involves all the senses, but
auditory memory
lar impact on languagedevelopment. MaggieJohnson shares theapproach adopted atGap House School.
Reviews 22Outcome measures, symbols,neuroanatomy, phonology,sensory motor developmentand AAC.
How I managespeech sounadifficulties 24Three opinions on the speechand language therapymanagement of an eight year oldboy, Mark.
MyTopResources 30
SPEECH & lANGUAGE THERAPY IN PRACrJCE WI HER 1997 1
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 4/32
N EWS & COMMENT
Forging partnershipsAs therapists we want to work with people to empower them,
but many feel our training does not eqUip us adequately.
However, an imaginative partnership of tutors, Clinicians and
outside bodies has enabled groups of speech and language
therapy students at University College London to gain
valuable, real-life experience while providing direct andindirect input to people who would otherwise not receive it.
Ann Parker at UCL would like to hear from service providers
keen to work with her on other such innovative projects.
Maggie Johnson is also keen to ensure her students -
children with specific language disorders - are equipped for
the real world. Group teaching brings particular benefits in
helping the children understand and accept their residual
auditory sequential memory deficits. Parents, teachers and
children are all advised of their part in compensating for the
difficulties these cause. This is an article bursting with practical
strategies for assessment and intervention, many applicable
to other client groups too . More specific practical suggestions
for eliciting velar plosives appear in How I manage speech
sound difficulties, but the more general process of case
management decision making can again be extrapolated.A speech and language therapy / occupational therapy /
nursing partnership is much in evidence in the Victoria
Infirmary Trust, where the special skills each discipline can
bring to the implementation of a standardised programme,
Sonas aPc , are demonstrated. Anyone who has worked with
elderly people in continuing care knows there is often
frustration and a sense of helplessness involved. However,
Lois Brown and the team show that, when the basics of
communication through touch and other senses are
addressed in a systematic and repetitive way, real gains in
quality of life can be expected and recorded. At the other
end of the age scale, children in early communication groups
can benefit from imaginative - and often 'home-made' -
sensory stimulation given in partnership with parents, asexplained in My Top Resources.
The importance of the senses is also fundamental to Neuro
Linguistic Programming, an approach based on using specific
linguistic patterns to challenge thought processes and bring
about change. Caroline Skelton provides a practical guide to
how it can help speech and language therapists build
rapport and give clients the confidence and the means to
work out the nub of their difficulties and address them.
A book on outcome measures, co-authored by Pam Enderby,
features in Reviews. In a recent lecture on the future of the
profession, Professor Enderby's warnings included the
implications of ever-shifting demographics,
epidemiology, technology, consumer
power and political landscape. All the
authors here show their commitment toforging partnerships and updating skills
to keep up with these changing
demands and needs.
Please give me a call if you too are
involved in interesting projects and
would be willing to share your
experience and resources with your
COlleagues through this magazine.
Avril Nicoll
Editor
Lynwood Cottage, High Street, DrumlithieStonehaven AB39 3YZtel/ ansa / fax 01569 740348e-mail [email protected]
SP [[CI 1& LANGUAG E THERAPY IN PRACfICE WI i'<'TER 1997
Books forschoolsIn a five yea r initiative, WHSmith is providing aro und half
a million free readin g books to
over 400 primary schools inthe UK.
The company is working withthe Department for Educationand Employment and teachers
to ensure the bookJist is best
suited to the educational needs
of the children. The schoo ls
chosen have all alreadydemonstrated th eir commi -
ment to improving li teracy.
Secretary of State for
Education and Emp loyment.David Blun ke tt, described it as
"an exce llent example of how
this government and business
can work together to achieve
objectives for the good of allparts of th e community and Iam con fiden t th at it will help
fu lfil the target for li teracywhich we have set for 2002 ."
Advances inpsychiauyAll exhibition at the Museum
of London raises questions
about the way people with
mental hea lth problems are
seen by soci ety.The co ll abo rative venture
between the Museum and
Bethlem Royal Hospital is oneof the events ce lebrating the
750 th annive rsary of th e hospital, the world 's oldest caring for
people with mental diso rders.It runs until 15 March [9 88
and includes an interacti ve CD
ROM covering the latestadvances in psych iatry.
Dewit,: MuseulIl o( London , tel .
0171 600 3699.
Fll.1encygamsAl l unforeseen benefitor speech recognitiontechnology fdr peoplewho stammer has
been noted by IBM.
People who stammerhave often foundcommunication bykeyboard less
cha llenging thanspeak ing, but thepaus ing and slowerspeech ra te currelltlynt>cessary to usepeech recognition
technology has helpedat least two usersimprove their fluency.IBM manufacturesthe VoiceType speechre ognition word
processing software.Deta ils: DUllcan Ross,IBM Speech BusillessMtJrltlgel; lei. 011256344741.
Pre-schoolprojectA new project willdraw togetherinfonnation andresearch on therelalionship betweenspeech, language andliteracy problems,
inves tigate preventionand arly interventionand d e Y ~ l o p are ource package ,1l1d
rra in ing.1 he joint pre-schoolYt.'1Uu re between,\IASIC and th eRrili h DyslexiaAssociation is beingfu nded bv GlaxoW dD lails: AFASIC, tel.01 71 236 6487.
TuberousSclerosisgeneRecent research has
uncovered the sec-
ond gene involved
in TuberousSclerosis, a co ndi
tion occurring in approximate-
ly 1 in 6000 new-born babies.
Although the tumours it causes in many parts of th e bodyare usually benign, they can lead to med ica] problems
including epilepsy, learning difficu lt ies and au ti sm. It is
hoped DN A test ing and reliable genetic counse ll ing wil l
now become possibl e.
Details: Th e Tuberous Sc/elosis Associalio l1 , Liule Barnsley
Fa rm , Catshi lL , Bromsgrolle, Worces lersh ire B61 ONQ.
2
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 5/32
hnslmas ca talO(lue 1997
AFASIC CHRISTMAS CA
Christmas card catalogues (" also including gift ideas), are
available from many organ! atio ns including:
• The NatioIUlI Autistic Society ' , 393 City Road, London EC 1VINE .
• 'Ine Stroke Ass ociation", tel. 017l 4904773 or write to Stroke Associalion (Trading) Ltd, Stroke
House, Whitecross Street, London ECl Y 8]1.
• AFASIC, teL Dl7l 236 6487(Reu,lers ml1y u·ish !O note that at lrust 0111' a r i l ADA , hIlS disrontillued its Christmas card suits 115
they failed 10 raise income, the charity belieJ'es as II result of Ille market TellChing saturation.)
TJupplementsuccessParents are claiming a
nutritional supplement can
help children with the
symptoms of dyspraxia,
attention deficit/hyperactivity
disorder an d dyslexia .Efalex contains a combination
of thyme oil an d the essen tial
fatty acids docosahexaenoic
acid, arachidonic acid an d
gamma linolenic acid. It is
believed it acts to maintain
eye and brain function,
compensating for unusual
biochemistry, and can be
taken by children from two
years old.
One parent of a twelve year
old boy with clumsiness, a
short concentration span,
lack of focusan d
atendency
to fidget said, "When Efalex
Preventing recurrent strokesAs part of Stroke Week, the fo llowing information was made ava il
able by the Stroke Association.
• New research shows 14 per ce nt of people who have had strokes
are not taking aspirin, even though it could reduce their risk of hav
ing another stroke. The Association wants to encourage wider useof long-term aspirin treatment and is urging GP practices to main
tain a regi ster of all their patients who have had strokes and to
assess each patient's sui tabi lity for aspirin treatment. They wou ld
also like to ensure that advice on reducing a lcohol intake and cig
arette smoking is clearly given. (Report: Preventing recurrent strokes:
are opportunities being missed?)
• A new leaflet to help people wh o have had a sLIoke reduce the
risk of having another has been produced (Keeping well after YOllr
stroke). It stresses th e imporlance of understanding the type of
sLIoke and treatment and the need to take medicines regularly, as
well as highlighting the value of regular blood pressure checks and
lifestyle changes. Details: The Stroke Association, tel. 0171 490 79999.
EWS
Business anddisabilityThe charity Scope and Talk
Radio have combined to survey
how businesses are ser.ving
people with disabilities since
the Disability Discrimination
Act came into force.
I! is unlawful for businesses
to refuse to serve disabled
people or, compared with
non-disabled people, to offer
goods an d services with a
lower standard of service or
at less advantageous terms.
The results of the survey will
be used to educate business
es, lobby Parliament an d
influence business and trade
bodies by highlighting areas
of good and poor practice .
Details: Scope / Talk Radio
Illfonllation Lille, tel. 01908
200022.
- /
SCOPE fOR P[OPLl WITH PA LSY
Cerebral palsydevelopmentA new module to develop
professional skills in the
diagnosis an d management
of people with cerebral palsyis being offered as part of a
Masters degree at City
University.
Gillian Nelms (ACE Centre in
Oxford) and Nicola Grove,
speech and language therapist,
will contribute to the
programme which is receiving
funding from Scope. Topics
such as motor patterns and
health issues, social aspects of
cerebral palsy, oral motor ski.lls
and communication an d MC
are included .
Details: Scope, tel. 0171 636
5020.
was launched we wondered
whether it might make a
difference. As pa ren ts
you will try virtually
anything to improve
lot of your child
an d it's all too easy to
think you've spotted an
improvement where
none actually exists. In
this case, however, we
struck gold ."
Efalex is available in
Boots, pharmacies,
health food stores an d
leading supermarkets.
Details: EfamollllformatiollLine, tel. 01483570248.
@ ~ n a ~ ~ P e 2 ~ developments are reponed in the annual
review of Action for Dysphasic Adults (ADA).There are now 13 affiliated self-help groups wi t.h fiv e o thers in process.CommUlliCilte workshops, which offer standardised tra ining to a range of
care professionals, are con tinuing and a medical teaching pack is availablefor use with medi caI students and professional s. The charity has alsobecome more involved in advocacy and empowerment. and held a training day on the subject in February.This year will see the publicalion of the 2nd edition of the NationalRegister of Language Opponuniti es, a systematic di rectory detailing allthe resou rces ava ilable across the country to people with dysphasia; it
will also be available on disk. ADA's regional co mmittee has a lso establi shed a working party to study the effec t of th e DisabilityDiscrimination Act on people with dysphasia .
Action fOl Dysphasic Adults, 1 Royal Street, London SE1 7LL, tel. 0171 261 9572 .
SPEEC H & L ~ N C L l A G E THERAPY IN PRA Cn CE W1N- I'ER 1997 3
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 6/32
TH E ELDERLY
Actlvatln Potential
Co fused, disorienla ed and
s o d a l ~ deprived elderlypeo Ie are ofle n ~ l e c r e d ascfiem g ~ ups. Sonas aPc is aackaged programme designedto meet their needs. Speech
and language and occupationaltherapy staff of the VictoriaInfirmary nRS Trust 0 Ine Itsimplementadon a benefits.
Sonas aPc was devised by Sister MaryThreadgold, a speech and language thera
pist in Dublin. Sonas is Gaelic for 'well
being' and aPc represents 'activating poten
tial for communication'. The multisensory
packaged programme on audio tape uses
music, singing, touch, smell and taste to
Rromote interaction and a sense of well
being amongst participants.
Training in the use of the programme was
offered to a group of professions allied to
medicine (PAMs) an d nursing staff in
Glasgow in 1996, in two half day work
shops run six weeks apart. The programme
provides for a group and a one-to-one
approach.
We now have groups of approximately
eight confused or socially isolated (often
dysphasic) clients attending with two facil
itators, in this case a speech and language
therapist an d occupational therapist. Eachgroup lasts 45 minutes to 1 hour and
groups are run at least weekly in four dif
ferent care of the elderly units with the
same clients attending. Some have contin
ued for 18 months while others are recent
ly formed. Some clients were known
already to ou r departments having had
therapy input and others were referred by
nursing staff, family or self-referral.
Clients are invited to attend and the choice
is theirs. Twenty five per cent of patients in
most of the continuing care wards attend.
FamiliarityAn audio tape takes the group smoothly
through a 45 minute session, commencing
with a signature tune and personal wel
come by the facilitator. The groups rely on
repetition, triggering memories an d
encouraging interaction. A group developsits own character as the weeks progress,
and a feeling of shared experience an d
familiarity benefits therapist and client.
The same tape is used every week. We have
not found this too repetitive either for
clients or ourselves, but the second side of
the tape provides a change in songs, cued
speech and music, allowing variety when
necessary.
The programme includes:
1. gentle exercise
2. singing
3. massage based on the simple 'metamor
phic' technique taught during Sonas aPc
training. Shoulders an d upper arms are
massaged gently by the facilitators moving
round the group, accompanied by music.
'The skin is ou r first medium of commu
nication" (Montague, in Sonas manual)
SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 1997
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 7/32
TJ IE ELDERlY
and touch is thera ' remark how " , " peU!lc. Clients often
nICe the ex 'notice other cli " penence is, and4, a rh ' rlhm' ,entsenjoYlng it too,
TU I Ica sect ion
5, a taste and smell sec tith e tape all ows the t: .,. on , For the latter,
~ o m e perfumed 0' 1 ' ao Hators time to rub
lfOllowed b), ha d ,IntO each client 's handn exeroses and '
ment to sll1elllh o ' I A' enCOurage_cOl, t !JOles '
very confu sed I' , ' a passive orc lent WIll fli
on the propenies of J.- 0 er a commentI " " uleo!/ 'Th' ,y , It sme ll s Il'k I - IS IS love-
e avender" "1me of a good soa " , t reminds
6, cued Speech _ ,proverbs ple!lon of we ll- known
7, a shon p 1' oem a lOwi ng I ' ,
!lm e after more acu' , ,«I mm g, llstenillo8 \ e secUons b
, an 0pponun ity for individ ' , 9, a closing song, udl pan lCJpation
MOdificationWe can modify o ur aaCCOUnt of In j ' 'd pproach to take(JVI lIal n d Itaped programme is £i ee s a lhough the
hard of hea ring I ' Ixed, We ensure ac lell[ IS s d
tape reCorder 'n d , ea te near th e, " p r o v I de
wllh Easi -comms for lh some elienlsIndi vidua ls if 1/ e seSSIO n, We ask
massaged, as n ~ ? ~ v : a n t Iheir shoulders
touched, A blind ryone enjoys being
approoches explained vma n has al/ the
liy sla nled and a I ' erbaily as he is eas " c lenl wah a h 'IS aSS lsled wilh P ' ' emlplegia
, asslve movem C
exerCise sections Th ellIS lor the' ose who abJ / are given lhe 0 0 ' re non-ver_
Channels of O l l 1 i l l ~ ~ i nunlty 10 use o lher
humming or rh'rlh ca li on, for example"
h
JU lilll
t e smg lng parts,
Ca l lap , ,
p ing dunng
ParticipationAs Ihe clients b
ecome'
{; 'I 'programme 010 , am i lar with Ihe
, re POSitive "nOled and a de ' , paIllopalion is
' crease In neo 'obVIOUS, Some /' ba!lVe aspens is
c lell[s are p "aII seclions ofc ' artlCJpatory ill
, ,ermg 10 'rem in isce Ol ho SlOg, dance and
' crs are 'but may enjoy on e secti qUI!'1 an d passive,On e lady is very ' , on 10 pan lcu lar,
, , aruuous andnlCa!lv(' Ulllil th ' lIncommu_" e exercises \ '1 h '
'
A em ersnother lady has her e ' ,
the early pa n of th yes !lgh tl y closed fore session b 'fi IIu y along wi lh the ta .' UI sings tune-
and will make "0 d pe In a srnall voiceO
th9nk the facill,b eye COntact. sillile a ndtalors at the d
t who is severel d en , l chatter and ,Y emenled uses con- '
in any s was ma la lly unable to pa rectlon Til ch '
nd sh h .. e altenng has, e as Improv d
th ' ,e turn taking, ,section , e ~ t r o d u C t l o n of the rhyt h_ '
of tOUche a a ~ a e a r s 10 enjoy the
eye Contaa and 'I taste, She main-ml
ernotionally labil: es rnore often,
the ea rly aCIIV't' CVA el lent cries dur, , l i es bu t co 'lclpale and ' n!lnues to
the' on comp letion, says shegroup,
AppendiX 2 Bt. Areod! • enef/rs roclienr YmOde, ponobl oClllrororsrime fo:r:,P ond Which c::rogromme effect;
i ! d 1 I f l e x i b l l ; : : ; ~ r e s P o n s e . be repeored ove:: ~ : ~ ~ h I S n ~ g l e c r e dvdUol cltenr lime ol/oWin oJ penodof;xperience. needs, deve/oPI'g corelulmOdili .0;': r : ~ ~ ~ l o r Conrlnued fa
~ " : : £ ~ : : : n n Q = n : ; : ~ ~ : ' / C r : : , ~ ~ u r e s . : " ~ : : ! n ' : ~ ~ ~ 5. Aforum for
oryreom. ng re/orions wirh ,,.
some field. . diSCUSSion . rilemeering rh,s hos e n o b l e ' ~ ~ orher rheroPisrs
i : d : ~ USint 0 1 : ~ : r ~ o n r h s . ro form on i n r e r ~ : ~ r s e s in rhe
onses wirhln rh lonol form WeVlduOIsresp ono/ observof oJroup
Appendix 1 Benefits to clients1. Arelaxed, Informal atmosphere to encourage freedom of expression.2. Time to share enjoyable experiences In asafe, empathetic
environment. 3. Freedom of choice to attend, with no expectations of performance.4. The opportunity for group members to develop and build relationships through tIme. S. Freedom to use any communication channel - verbal or non-verbal, touch, gesture, facial expression or eye contact. 6. Therapists' obsenation of the individual's preferred sensorychannel and reinforcement of Its use in activities of dally living.7. Aroutine and predictable sequence of events allowing severelyconfused clients to become familiar with the material and the othermembers.
8. Reduction in tension and increase in confidence and self-esteem.9. Acknowledgement of personal Integrity in confused people.
. ng ond e n r i c h i n ; ~ : : ~ for
rhe need forUor/on oVer rimeRcrtonol ossessmo/orm ond o n f ~ r m o l o s s e s s m ~ n 0 norurol e n v i ~ n r , observorion
10 vIgorously and 1h len s e joins
'rhythrn ' ~ l i s s l ' O en co nt rib utes to theh ' n seClion B ,l -
S e appears relaxed and I _ ' , y U,e end egroup OVer r i m ! ~ n rroce onhe other group rn b lappy, smiling at
Appendix 3• Considerations1. Illness and disability in the group can cause inconsistentnumbers, or disruption of client mix.2. Appropriate accommodation is important; aquiet room,large enough to have acircle of up to 10 people, some inwheelchairs, with facilitators moving around to assist inexercise and perform shoulder / arm massage. One of ourclients likes to dance during the music programme and spacewithin the circle for this tobe done safely was necessary.3. Avoid interruptions during the group.
4. Staff shortages can interrupt continuity.S. Time is needed to prepare and transport clients to theSonas room.
SPEECH & LANG ' , , VAGI: lH LRAPY IN PRA
en.F
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 8/32
THE ELDERLY
Appendix 4 - Speech & Language Therapy record sheetSonas ape
name diagnosis
ward communicationmental state/mood
~ a t eeye contact
smiling
vocallslng
talldn! -touching
e ~ r c l s l n !~ i n g
rhythm lcaillovement
nonverballnitlatlol of communication
verbaflnltlatlon of co..munlcatlon
sleeping
shouting
hitting out
~ r y l n ! l m o a n l n !purposeless movemnt
cJosed eyescryln!lmoanlng
obsenatlons of pos ltll. partlctJation
observations 0' ne!atlve r t l c l ~ a t l o n
_.
codesparticipation mood/communication
o did not participate in activity P passive/ little or no spontaneous communication
1 required assistance/prompting to participate in B bright/chatty
activity A agitated/verbally agg ress ive
2 responded spontaneously
One-to-oneA second twe nty minute audio tape is
designed for use on a one-to-one basi s
with clients. It cont a ins timed sections of
music, so ng and poetry whid] lead the
faci litator through gen tle massage of th e
c l i ~ n t s hou lders, back of neck, hand s and
head.
This individual approach is very useful
with severely dement ed or withdrawn
clients o r those with very disruptive behav
iour who may no t be able to attend group
sessions. We have used it successfully to
red uce agi ta tion in a severely confused
client. Typically clients become visiblymore relaxed during the massage an d
spontaneously cha t to the facilitator, per
ha ps pro mp ted by familiar tunes an d
mem o ries invoked by the music or poetry.
OutcomesBenefi ts to clients an d facilitators are listed
in Appendices 1 and 2. Through tim e,
clients demonstrate improved well-be ing,
self-co nfidence, se lf-esteem a nd IIU St.
The behavioural signs of we U-being are
discussed by Kitwoo d (19 96 ) and are
observable following repeat ed Sonas gro up
attendance:
a) demonstrating pleasure
b) bodily relaxation
c) assertivenes s
d) exp ress io n of a range of emotions
e) sensi ivity to the emotional needs of others
f) humourg) crea tive self expression (su ch as singing
an d dancing)
h) helpfulness
i) affect ion
j) self respect (such as concern aboutap pea rance)
k) acceptance of others wh o also have a
dementing illness, or other disability.
Alth o ugh difficult to mon itor objectively,
care staff an d relati ves have noticed gene r-
a ll y improved alertness, happin ess and
relaxa tion following the gro up in so me
individuals and quality o f life is improved
at th e time of the gro up . T he progra mm e
can "m anage" behaviou r in some noisy,
distracted, disrupti ve or sleepy cl ien ts.
Clients have demonstrated their trust by
their continued free choice attendance ove r
a long period of time. Individ uality in
responses is allowed. Dysphasic clientshave benefited from the socia l and com
municative aspect of the group and all
have tolerated the mixed memory ab ilities
and physical limitations of othe r clients .
SPEECH & LANGUAGETHER APV IN PRACTICE WINTER 1997
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 9/32
-- -
---
TJ IE ELDERlY
Appendix 5 - Occupational Therapy record sheetSonas ape
name diagnosis
ward communication mental state/mood
elat. 1i$POIiDED -o SI6UTUII mE
-
PARTICIPATED IlIlmo SOIiG
PARTICIPATED III WICISES
)!mClPAnJ III SIIiG AlOIiG (0 J IIJOYJD MASSAGE. DIIIII
PDnCIPATlD WITH IIiSTlUfjEIiTS
AIISWERED pROVE.as
OFFEIED PARTY PIECE
P A I T I ~ P A l E D III SlIIG AlOIiG PAIIIClNnD III nOSlliG SOIiG
IISPOIiSE TO SWIOII (+VE OR - VE)
MOO D/COMUILICATlOIL
codesQarticiQation mQod/communication
0 did not participate P passive or no spontaneous communication
1 required assistance/prompting to participate in B brighUchatty
activity A agitated/verbally aggressive
2 responded spontaneouslyI
Appendix 6 - Grouprecord sheet
SOllAS oPcgroup record sheer tor
Adaily reCord of chan '. wordcommunication as a r ; s e u : ~ ~ e h a v l o u r interaction and
The programme's implementation has a Sonas diary, sum- Ch 0 attending 'SONonge may occur In any ot rhe tol/ Wi AS aPe' grouphighlighted potential for enjoyment marising the aims of
0 ng areasthrough well-being activities for the more the group an d atten
confused patients. Other such options dance details, to I DATECOMMEllrSye conroct
include privately arranged aromatherapy, involve carers andsmilingan therapy (in two units), social activities relatives - panicu
and outings run by occupational thera- larly useful for the VOcal/singpists, music in hospital, relaxation, latter when they ro/klngTherapet service an d reminiscence . can only visit in
rouchlngthe evening or at
exercisese elopments weekends. Some
We are continuing with ou r groups and relatives or singingmore staff are being offered Sonas training friends, includingrhythmical movemenr
workshops to allow further groups to stan. a local minister,
The Sonas aPc training is suitable for all have sa t in on a making aconrrlburloncarers including nurses, volunteers and day group bu t this using musical Instruments
Inreracrlng In rhe group
USing gesrure
complerlng proverbs
responding ro
IJ massage
2) rosre
3) smell
4) music
cued speech
centre staff. Running the groups requires has to be han
commitment and consideration died with care.
(Appendix 3) but the rewards keep us Some of the
motivated, as do interdisciplinary meet- e v a l u a t i o n
ings and contact with Sonas aPc trainers. forms we have
We are keen to maximise the potential for developed are
staff involvement and carryover. To this in appendices 4
end, we exchange information on clients' - 7; the speech
strengths at the end of the group, attempt ilnd language
to provide a written repon on client atten- therapy record
dance approximately every 10 weeks, dis- sheet (4) , the
playa client list in the ward with group occupational
aims boldly presenLed and disseminate therapy
information at social rounds with ward record sheet
staff. We are developing record sheets an d (5 , a group
SPEECH & LANGUAGE THERAPY IN PIMCTICE WINTER 1997 7
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 10/32
Appendix 7 - Performance Evaluation sheet
Sonas aPc . Performance Evaluation
nAME: WARD:
- - - - - - - 7 ~ - - ~ ~ - - - - 4 - ~ - - - + - - - T - - ~ ~ -O. Too III/absentI. Refused2. Required encouragement3. Passive
4. Came willinglyIOrientation/memory
O. PoorI. With prompting2. Good
I Interaction/relationshipsO. Offered nothing
I. Spoke only to leaders2. Interacted with one another3. Interacted freely4. Helped others
IContribution
O. Offered nothingI. Disruptive2. Contributions Inappropriate3. Contributions appropriate
record sheet kept in case notes (6) an d a
Performance Evaluation sheet (7) left in
multi-disciplinary team notes in the nurs
ing notes in the duty room.
This holistic programme is proving a wor
thy tool for use by PAMs with confused,
disorientated an d socially deprived elderly
people. As therapists we feel we have skills
in observation, interaction, running
groups, communication and diagnosis
which allow us to implement it very effec
tively. For us, Sonas aPc is a quick and
effective way of creating rapport an d giving
a greater insight into an individual's needs
and potential. 'it allows us to respond to
these needs and to have informed an d real
istic exchanges with nursing staff, relatives
and other disciplines.
Lois Brown is a Speech and Language
Therapist, Pauline Dunsmuir and JulieLoudon Occupational Therapists andRhona A1ontgomery a Speech and
Language Therapy Assistant with Victoria
Infirmary NHS Trust in Glasgow.
Iinterest/panlcipation
O. Offered nothingI. Unco·operatlve2. Joined In whh persuasion3. Actively panlclpated
I Enjoyment/humour
O. Showed no signs of enjoymentI. Occasionally showed pleasure2. Enjoyed majority of session
3. Thoroughly enjoyed session
I level of activity
O. Persistent restlessness
I. Intermittent restlessness2. Appeared calm and relaxed
IConcentration/tolerance
O. Poor
I. Patchy2. Good
ISens!dv!ty to emodonoi needs of others
O. PassiveI. Insensitive2. Sensitive
Summary
A version of this article has been submitted
to the British Journal of Occupational
Therapy.
References
Kitwood, T. (1996) Not Them and lis
Simply Us Training Pack. Dementia
Services Development Centre, University
of Stirling, Stirling FK9 4LA, tel. 01786467740.
Threadgold, Sister M. (1995) Sonas aPc
manual. Dublin.
Further information about Sonas aPc is avail-
able from
Rosemary Hamill (MRCSLT, Dip. ACS, CMH)
Training Development Officer
Sonas aPc
Belvedere Place
Dublin 1
tel/ansa/fax 00 353 1 8366874
Sonas aPe facilitator:
Questions ~ A n s w e r s What are the benefits of a Familiarity for this client group builds confidence,repetitive programme for•••MiW"IWJ.MI reduces tension, leads to pOSitive participationelderly confused peo ple? and triggers memories.
How is Sonas aPc im proving A natural setting allows more accurate assessmentspeech and languager l . I I " I ~ I * L \ \ ~ ' ~ ~ of individual needs while therapeutic skills in
therapy provision? assessment, diagnosis and interaction enhance the
benefits of the set programme for the clients.
Are developments As well as highlighting the benefits of 'well-being'
I I I I I I I I activities for this client group, opportunities foraking place as a result ofthe programme's involving relatives and carers are Deing followed up.im prementation?
SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 1997
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 11/32
COUNSELLING
Neuro Linguistic
Pro ramming Speech &
Languae
-"'-hera i 'sStudying
Neuro Linguistic
Progranlming
has made a
significant impact
on the way
Caroline Skelton
works as a
speech and language
therapist.
In thisarticle she shares
its principles
and how she is
putting it
into practice.
~ u i d e have always been interested in using counselling approach
es and psychological models within speech and language
therapy. In 1994 I took a short course in hypnosis and,
when I started in a specialist voice and fluency post in
Chesterfield later tha t year, sought supervision through the
psychology department. I was lucky to be offered this by a
Consultant Health Psychologist experienced no t only in
using trance states but also in Neuro Linguistic
Programming (NLP). I have found NLP extremely useful and pow-
erful in my work, and feel I am only just beginning to tap the huge
potential it offers for speech and language therapy.
What is NLP?Neuro LinguistiC Programming began in the 1970s In Ca liforn ia. It
linked observable linguistic patterns to neural (thought) process
ing to find new ways of understand ing behaviour and to pro
gramme (facilitate) change .It was conceived by John Grinder. a linguist, and Richard Bandler,
a mathematician and psychotherapist. who were interested in
human excellence.They stud ed a number of therapists who were
outstanding in their field to distil the crucial elements of their com
munication.Their aim was to model expert behaviour and lan-
guage patterns. Bandler and Grinder's work identified interesting
patterns of language and non -linguist ic communication, and also
led to the understanding that these patterns represent the super
ficial expression of underlying thought processes. Grinder and
Bandler realised the therapists were using spec ific language pat
terns to challenge their clients' thought processes in order to open
up their thinking and make change possible.
As NLP developed, it focused on the processes and structure of
thi nking: how we perceive the world and how we organise ourexperience, memories and learning. By studying these processes
in high achievers we can model their skills , and by understanding
faulty or ineffective processing, we can begin to make positive
changes - for-ourselves and others. NLP is now taught w idely, and
SPEECH & LANGUAGE THERAPY IN PRACTI CE WI'lTER 1997 9
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 12/32
COUNSELLING
the basic principles of modelling have been app lied to bu sine ss
and spor'ts as well as therapy and education.There is a growing
resource of NLP technology for therapeutic use, with change pat
terns designed to tackle particu lar types of difficulty such
dysfluencyCase 2 - CFCF referred herself for therapy for a stammerShe presented with mild d y s ~ u e n c y
characterised by repetitions and blocks
as phobias and weight loss. with high levels of avoidance atBasic Principles dysarthn'a ~ word and speech levels. SheWe often interp,-et other people's " " attended for eight therapybehaviour intuitively; a certain look . r - ~ e I LN ."'" sessions, working on aor tone of voice gives us a feel- / \..-d.::) - ~ block-modificatIOning about the person's state of LN was referred fo r speech and language therapy, " ' \ approach. CF mC!dE
mind. IncreaSing the accur!- for mild dysarthna resulting from a brain tumour. LN s .\ good progress In
cy of our Interpretations speech had a fast rate, was larrcely intelligible, but occasionally reducingthrough good use of sen- I d Th fi d . h d. . 'd dsory acuity is fundamen- Surre . I erapy ocuse on sowing t e rate an Improving avol once ontal to the p,'actice of articulatory accuracy. LN made good progress with the ImprovingNLP By improving our exercises, but still reported difficulty in slowing his . ate . . . ~ u e n c y contrcobservation of sub tle particular Situations, resulting In frustration and loss of Intelligibility. However ShE
ch ange s in others, LN contrasted his VAKOG experience of "good" versus "bad" reportedwe can ma ke con- speech. In describing good speech attempts, LN was visually aware of continuedsc ious and less sub- his listener, auditorily aware of his own voice, and aware of planning / difficulty wiljective in tel-pret a- I htions ba sed on an sentence construction in his mind prior to actually speaking. In the bad teep oneindividual's unique speech attempts, LN's visual awareness was extremely limited, he had calls at wo'and minute varia- no auditory representation of his own voice but was acutely aware of when shet ions in behaviour. unpleasant tightness in his chest and generalised body tension. Having was requireNLP also supports elicited VAKOG data in some detail, we "mapped across" sensory to repeat athe premise that representations from bad to good, for example by expanding visual specific
~ ~ t i : ~ r ~ e ~ ~ _ awareness and filling in the absent auditory channel. messc:!e. Sheingful communication, Interestingly, during this process, LN linked his feelings of frustration blockeand gives the therapist to similar feelings experienced as a child when, as one of uncontrollably,add itional too ls to bu ild seven children, he had had to compete for attention and and sometimes trapport with even the most had not been "heard" to his satisfaction. LN felt that the phone downchallenging clients. NLP IS expe- NLP therapy had been an important part of his without saying a singriential rather than theoreticaLbut process in modifying his speech, and was word.there are a number of basic princi- " positive about general ising the gains he We discussed in detailpies or pre-suppositions which need to had made. He will be seen on a exactly 'vI/hot CF wasbe understood. Here are a few:I. We experience the world thmugh our review basis. visua/ising, hearing and feelingsenses, ie .visual, auditory, kinaesthetic. olfactol-y and each time she mode the call. It
gustatory (VAKOG). Our language and vocabu lary re nect became apparent that even before ShE
our sen sory processing in a literal manner (eg. " I see what you started to dial the number she was "hearingmean", "this sounds interesting","1 fee l sure", "that stinks", ' 'I've got herself stammering on a particular consonanthe flavour of that"). I We used on NLP swish pattern to change2. Our learn ings and mem ory con sist of VAKOG data. Changing this unconscious rehearsal of the stammerthe qual ities of our sensory representations (size , colour. pitch, volume etc.) wi l change the qu ality of t he experience. into the desired smooth speech, so that eac3.
W e use our exper ience to create our own map of the world. time CF dialled the number. she automatical,Each of us operates from our individual ma p. The "map" is not the imagined saying the words ~ u e n t l y . We alsosam e as the "te rr itory". used a circle Of excellence which helped CF
4. Ou r behaViour is goal-dl-iven. (athel- than sim ply responsive to to approach the situation in a calm state. Cst imulus. All behaviour has a posit ive intention (conscious or filled her imaginary circle with coloured lighrunconsc ious) and at any given time we ma ke the best choice avai l- representing relaxation and confidence. Byable to us. I'
S. Most of our behaviour is carr ied out unconsciously. Ou r con- stepping into her circle prior to making scious minds can process only a limited amoun l of information at telephone calls or entering other stressful any one time. situations, she was able to access a 6. W e are limited by the choices we perce ive, therefore it is help- controlled state, ful to w iden our percept ions to increase the range of options Six months later. CF reported that she was avai lable to us. able to make the phone calls with only7. All the resources we need al-e availabl e to us from dwect or I d d
occasiona easy soun repetitions on , mol"indirect experience. C
importantly, with a feeling of control. Fcontinues to be seen on a long-term reviewrinciples into practiceI attend ed an NLP Practit ioner (OUI'se in 1996, and hope to com Ibasis.plete my Master Practitioner training in January 1998. In co mmon
10 SI'I'I'CH & LANGUAGE THLlv\l>Y IN PRA CT ICE WINTER 1997
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 13/32
CO U SE LLlN
At 62 years old. AM suffered a severestroke with right-sided weakness andmild dysphasia. This came as a seriousblow to AM and her husband who
were looking forward to retirement inthe country. She was using a wheelchair, was dependent on ner familyand had been forced to give up abusy social life. Nine months after the
stroke. AM had only occasional word
finding difficulties resulting in hesitancy.but t his was made significantly worseby anxiety and lack of confidence. AMad it ted she was avoiding speaking-it a Ions and limiting her return tosocia lsi g because of this anxiety and
lackof
corfidencein her
speech.In a light trance. AM identified the
resources she needed to tackle socialspeaking s ations. She was able torecall t imes In her life when she hadfelt the determination and courageshe presently lacked. With guidance.AM accessed these resources fromher past memories. was encouragedto re-experience those strengths int he present and to picture herselfusing them in identified situations inthe future. In the weeks following the
session, she did in fact tackle severalof the previously feared situations.She reported that although herspeech had not been fully fluent. shehad a different attitude and herconfidence improved through copingwith the challenge.
was referred to the speech and language therapy department with a three month hi story of severe dysphonia'flu, which meant she had been unable to perform her job. She worked in personnel management in a largeundergoing major change. Her department was short-staffed and LJ had been under a lot of pressure, but
was reluctant to accept her persistent dysphonia might be stress-related.attended four therapy sessions to work on relaxation, deconstriction of the larynx and vo ice facilitation. She was
to achieve good voice quality on single so unds within the first session, but after four weeks was still unable tovoice beyond phrase leve l.
session was spe nt on an NLP reframing p,attern. This technique assumes there is a positive intention fo r allIt also relies on the metaphor of "parts '. The client is asked to set up a communication with the part of
w hich is controlling the unwanted behav iour, i.e. the dysphonia. The client then asks this part what its intentionIn a I ~ g h t trance, LJ was able to access this part. Its initial response was concerned with slowing down, which LJ
x ing. After further questioning, she realised the underlying intention was to look after her health. LJ
thi s as a wo rthwhile aim. and we then talked about other options for pursuing this aim in a more adaptiveLJ came up w ith new choices and negotiated w ith the part to relinquish its original strategy in favour of a
w alternative. The final step is an ecology check, to ensure the new strategies are acceptable and appropriate.completed the reframing, LJ's voice started to improve rapidly, and after the following session she was put on
later, LJ reported that her vo ice had been "normal" in the interve ning period. She had chosen towork on a part-time basis. and had been able to talk on the telephone and in Important meetings without
She was discharged.
SPEECH & lANCUACE TI-iERAPV IN PRACTICE WINTER 1997 11
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 14/32
COUNSELLING
with the best of my own learning experiences, NLP has been Caroline Skelton is a Specialist Speech and Language Therapist for
familiar enough to support and explain what I already know, whi lst Chesterfield Royal Hospital NHS T r u s ~ cha llenging limiting beliefs and allowing me to expand my learning Calow,
further. Derbyshire S44 5BL,
Four case histories are described (Cases I - 4) to illustrate how I tel. 01246 277271.
have begun to use NLP in speech and language therapy. Some of
the change patterns are more effective using a trance state simi lar Further information on NLP training from:
to deep relaxation . I always discuss this with the patient first and ask Centre NLP
them to sign a consent form for hypnosis. My clients are all adults PO Box 178
with acquired disorders or dysfiuency, and I have tended to use Leiceste r
NLP patterns where I already have a counse lling role. However, LE38ZU
the use of sensory acuity and rappor t ski lls is cen tral to all thera- tel. 0 I 16 2873356.
peutic intervention, and equally applicable to any client group.
I have been fortunate in attending the courses and receiving Recommended reading:
supervision for my work but, for anyone interested in finding out Bandler, R. and Grinder, j. ( 1979) Frogs into Princes. ISBN 1more about NLP. there are a number of tr aining companies who 870845-03-X.
offer introductory courses and most good bookshops now sell a O 'Connor. j. and Seymour. j, ( 1990) Introducing NLPThorsons.
reasonable range of titles. I look forward to hearing other thera McDermott, I. and O'Connor, j. (1996) NLP and Health. ISBN 0
pists' experiences of N LP 7225-3288-1.
This article is the first in a short series looking at how speech and language therapists have used training in other fieldsto assist their work. Personal construct psychology and family therapy will be featured in future issues.
Questions AnswersWhy does NLP work? NLP observes patterns of communication, relates
them to underlying thought processes and uses
language to challenge ana open up the mind to change
How can NLP inform111i'MfMllinterpreting behaviour become more honed tnrough
• tiI• • • The skills of tuning in to a client, building rapport andspeech and language '
therapy at a basic level? NLP training. What does NLP add to NLP recognises the importance of confidence andtraditional speech and attitude in overcoming communication difficulties and
1 rMU allows people to identify and prepare positively foranguage therapy approaches?II.!! difficult and stressful situations.
RESOURCE UPDATE. _.RESOURCE P D A ~ . .RESOURCE UPDATE..
effect of Down 's Syndrome on
DysfluencyA booklet Dysfluency, Stammering &Down's Syndrome has been producedby the British Stammering Association
and the Down's Syndrome
Association.Written by Monica Bray, Leeds
Metropolitan University, the booklet explains dysfluency and the
language and fluency and usesthe demands and capacities
model to explain how people
can help (£3.50 for 10 or 40p
each inc. pap).The BSA can also supply copies
of other books, includ ing a new general text
The Stammering Handbook, by Jenny Lewis (Vermilion) andCoping with Stammering, a self-help book for adults, by Trudy
Stewart and Jackie Turnbull (Sheldon Press).
Details: BSA , tel. 0181 983 1003 / DSA , tel. 0181 6824001 .
12 SPEECH & lANGUAGETHERt\PY IN PRACTICE WINTEH 1997
Signalong S a f e ~ for newTheSIGNALONG AT
motHersWORK series continuesAn updated leaflet on safety at work
with the publication offor new and expectant mothers has
General Retail (£17.50).been issued by the Health & SafetyThe vocabulary isExecutive.aSSOCiated with super-An amendment introduced in 1994 tomarkets, DIY stores,1992 legislation means if particulargarden centres, illingrisks cannot be avoided by otherstations, dry cleaners
and hairdressers, means, employers need to make
Changes to the working conditions or
safety, equipment, hours of a new or expectant mother
tasks and job titles . or offer suitable alternative work, or if
The next book in the this is not possible, give her paid leave
series will deal with for as long as necessary to protect her
Horticulture and health and safety or that of her child.
Agriculture and The leaflet is aimed at employers,suggestions are employees and representatives.welcome . Details: Kay Ref The Management of Health andMeinertzhogen, tel. Safety at Work (Amendment) Regulations01634832469. 1994, ISBN 0-11-043021-2, £1.10.
including health and
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 15/32
SPECIAL FEATURE
In two papers, the
Speech and Language
Therapy Service of the
Camden and Islington
NHS Trust and the
Department of Human
Communication
Science, University
College London (UCl)
report on joint
projects combining
genuine service
requirements with the
need to offer highquality, supervised
cHnicai practice for
students.
A service-
I.Groupp'lacements
in Under Fives
Centres
2. Groupplacements
With adults with
a leamingdisabilityyAnn Parker and
Keena Cummins
I. Group placements in Under Fives Centres This project was designed to solve two well-known problems. Thefirst. limited staffing resources, is sometimes given as a reason for the
second, a shortage of clinical places for speech and language therapy
stud ents, but we aimed to combine effective use of limited clinical
resources for children under five years of age with a consistent. well
sup ervised and high qualiry learning experience for stud ents.
§ ® N ~ ~ ® ~ ~ ® ~ d J ~•
In reassessing the available resources wi thin the Camden and
Is lingto n N HS Trust Health Centres' team, it had become increas
ingly apparent that a policy of prioritisation was required . The
available literature outlined the importa nce of ea rly intervention
and its positive effect on prevention of secondary emotional disor
ders, language difficulties and ultimate cost effect iveness (Ward
1992), an d so the system for speech and language therapy within
local Health Centres had been tailored to focus on parent interac
tion using video play-back (Kelman and Schneider 1994).
Howeve r, it was felt many children continued to be missed fw m
the process, particularly in some catchment areas where failure in
attendance was still high. A development was therefore required to
address th e needs of th ese children, without diluting service delivery within Health Cen tres where parental involyem ent was a pri
mary target. an d without increasing waiting lists by relocd ting staff.
l ~ ~ ~ D i j ~ ~C O p p © r t ~ f f l l ~ ~ ~ ~ ~A review of clinic-based learning opportunities available to the
Department of Human Co m muncation Science, UCl, ha d high
lighted the value of facilitative, adult lea rn ing mo de ls (Marson
1990) in develop ing s tuden ts' confiden e. Where students were
given a range of genuine responsibi lities they were helped to
achieve a realis tic picture of the role of the speech and language
therapist, in terms of both work with clients and general clinical
management.
While the learning environmen t nee ded to be supportive and struc
tured, and provide a hierarchy of learning, experience with paired
an d group placements - more unusu al in service settings but stan
dard practice for university-based clinics - seemed to indi ca te co n
stant one-to-one supervision, while va lued at many stages, was not
SPEECH & LANGUAGE THERAPY IN PRACflCE WINTER 1997 13
5
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 16/32
SPEClAL FEATURE
necessarily the ideal for every placement. Feedback from our stu
dents matched reports from other initiatives (Grundy, 1994;
RCSLT, 1996). Placement in a group of peers seemed to offer a range
of additional opportunities, such as learning to work in a team, use
of peer support and feedback and a degree of responsibility for a real
task which supported confidence in problem-solving approaches.
Group placements in a singl e department provided a consistent
experience for the students and a greater number of placements
under the supelVision of a sma ller number of clinicians. They also
offered a view of the student team as a resource, rather than a drain
on the resources of the speedl and language therapy service.
l P U l l O ~ ( Q ) ~ © ~ L l l Y .The underlying philosophy of the student learning process for this
particular project was that of a hierarchy of learning, making use of
a didactic language enrichment programme in association with an
introduction to the interactional model through student self-analy
sis. The Let's PIa), Language Scheme (Barnell an d Fletcher (985)
was chosen because of its definition as an enrichm en t programme,
rather than a therapy tool, its strengths being provision of a basic
screening procedure, with identification an d differe ntiation of children at risk of communication difficulties, an d structured group
activities provided in a specific daily programme.
The students were to take responsibility for lea rning through gener
al peer support, regul ar video-recording for daily peer feedback and
review and constant telephone access to supelViso rs Video equip
ment was an essential tool for the project and the key support sys
tem was a weekly tutorial , provided jointly by staff of the Camden
and Islington Speech an d Language Therapy SelVice and UCL.
P j ( Q ) ( C ® ~ ~PreparatOlY work for the project included meetings and policy
decisions between the Educmion Department concerned, the
Camden and Islington te am, UCL clinical tutors and the Heads of
Nurseries, as well as obtaining parental consent for both the pro
gramme and the use of video-recording. Four Under Fives Centreswere selected thmugh identification of the highest ratio of children
considered to be at risk of language delay.
1r[jatUlill l f(iJg[n addition to checking the students' e.,xisting knowledge of a range
of relevant formal non-verbal and communication assessment pro
cedures, their direct preparation for the project included two train
ing days during the first week of the block placement. interspersed
with two days within the placement environment. Staff members
from the Centres and UCL contributed to both training days to
emphasise and support the cooperative nature of the project, but
the content was primarily devised by Camden and Islington teams .
Day on e focused on orientation, aims, expectations and anxieties,
Health and Safety issues and uaining in use of the Let's Play
Language Scheme. For the second day, each student was requestedto bring one video of themselves interacting with a child and on e
video of a group of children.
Day two focused on interaction and problem solving. Students
were introduced to child an d adult interactional styles (Weitzman,
1992) and the parent-child interaction model as described by
Kelman and Schneider (1994) with specific relationship to parents.
,This system was then adapted for student use . Subsequent group
tutorials provided support for individual student 's assessment of
their own interaaion abilities, abstraction of an adaptational aim
for the next stage of wo rk and problem-solving focused on situa
tions which had arisen within the working environment.
~ ~ © l ( C ® m ~ l I l l ~Each pair of students spent the first week of the four-week place
ment screening all children within the Centres. Their second week
involved setting up a timetable, appropriately grouping the chil
dren and embarking on the programme. The third an d fourth
weeks involved continuation and extension of the group activities
from the programme, adapting activities where relevant, monitor
ing development through note-keeping, re-screening and comple
tion of a summary report. All therapy was videoed and individual
video interaction sessions were carried out on a daily basis
T l U I ~ ( Q ) [ j ~ © l ~ §Tutorials were held in a weekly, hair-day session and focused on :
i. Feedback and problem-solving.
ii. Feedback of each student's personal child-adult interaction,
including identification of a new individual aim.
iii. Group video: discussion of behaviour management an d adap
tation of activities.
[n this way students were introduced to case presentation, an d were
encouraged to discuss issues that might lead to resista nces, blocks
or obstacles to learning (Boyd Webb, 1984) an d thereby limit the
efficacy of their worl<.
f o \ ~ § ® ~ § W r J ® I i l l ~Throughout the programme students completed a Personal
Professional Profile which included personal skills, clinical skills
an d professional behaviour as demonstrated. In addition , subse
quent to the placement, they completed an assessment question
naire an d were provided with personal assessment grades. There
was also a closing summary meeting in which th e process was
reviewed , identifying goals which were met successfully and those
which would need to be adapted in the future.
O [ U ] ~ ( g ( Q ) m ® ~At reassessment all the children had improved since screening.
Those children whose rate of change was reduced were recom
mended as needing to be referred to the speech and language ther
apy selVice. Feedback about the process was provided in writing
through individual forms tailored for students clnd nurseries.
The students reported they had benefited from having insight into
the working nursery environment, experience of liaison with and
support from Centre staff with in-depth knowledge of children, the
opportunity of learning about organisation an d time managementin association with working with children at a range of develop
mental stages. They also appreciated the opportunity to gain expe
rience of children with and without communication difficulties,
both within groups and on an individual basis, an d to give lan
guage support to children who normally might not have the chance
to attend speech and language therapy.
The nurseries reported they had benefited from being provided with
assistance in identifying or confirming children with language diffi
culties, a model of speech and language therapy, and the process of
additional language enrichment. They noted the children benefited
from structured and specific input in regular sessions, more close
contact work and an increase in confidence and general skills. The
students were also said to have provided a positive contribution to
organisation and record keeping. All Centres reported they would
like to be included in any further pilots canied out.
lE1flf@ ~ ~ ~ ®®(ffi [j[JU [JUg
Pine & Horne (cited in Boyd Webb, 1984) olltline some specific
prerequisites for effective Jearn ing. They sta te the learning environ
ment should
a) encourage people to be active
b) emphasise the persona l nature of learning
c) accept that difference is desirable
d) recognise people's right to make mistakes
e) tol erate imperfection
f) encourage openness of mind and trust in self
g) make people fee l respected an d accepted
h) facilita te discovelY
i) plll emphasis on self-eva luation in co-operation and
j) permit confrontation of ideas.
Ou r discussion with th e students indicated that group placements
with a genuine purpose, structured as a team project, can offer a
14 SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 1997
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 17/32
SPECIAL FEATU RE
strong model in all of these areas, with experience that is comple
mentary to that provided by individual placements.
A d d ~ ~ ~ ~ r r 1 © l ~ § ~ N ~ { c ®The students provided an additional service, augmenting existing
support for the needs of the children within the Centres, providing
an essential link and model to Centre staff and paving the way forfurther training and input addressing more specific communica
tion difficulties. In adopting an interactional model, the therapists
were also able to learn about transference of skiJls from one caregroup to another, in preparation for empowering Centre staff
through this technique. It was exciting to work with such a highly
motivated group of students who were open and prepared to takerisks with ideas and questions, and willing to learn from mistakes
in order to develop their personal sl<ills.
C ( Q J I n l ~ ~ ~ ~ ® I n l { cLiaison and continuity 0 interaction between lecturers and supervis
ing therapists were optimum. The experience obtained was con is-
tent for each student, making assessment of progress easie.r and more
definable, and the mutual understanding between those irl\ h· dmore explicit and detailed. A larger number f students provided with a strong experiential learning environ ment an I the range of
experience and responsib il i[ enrourag d an inCIease in students'
confidence. The establ ishme.nt of a commitment to a group placement with joint aims means that a more consistent relationship,
with more frequent contact and discussion, can be formed betweena University-b ased tutor and the speech and language therapy ser
vice, to the benefit of all the panicipants in the project.
ih® [ F u ~ ~ [J®While modifications and improvements will undoubtedly beinvolved, we are continuing and developing this approach in further
under fives centres and other settings. Specific developments
include extension to other groups of students and provision of
workshops in under fives education centres by speech and languagetherapy to augment understanding of the needs of children withspeech and learning difficulties through an interactional model.
At University College London, we have built into our placement
system a stronger focus on paired and group placements, withdevelopments such as workshops for our students to help them
make the most of opportunities to work in such teams. Other
workshops for supervising therapists and University-based tutorsenable discussion of ways to support the development of students'
skills, autonomy and confidence in such settings while providing
high quality supervision. It is hoped all our students will have the
opportunity to learn in paired and group service-based settings as
part of their clinical experience.
References Barnett, M. and Fletcher, s. (1985) Let's Play Language. Cambridge:
LOA publications.
Boyd Webb, N. (1984) From Social Work Practice to Teaching the Practice of Social Work. Jorll"lll1l of Educlltion for Social Work 20 (3).
Grundy, K. (October 1994) Peer placements: it's easier with two.
CSLT Bulletin.
Ke!man, E. and Schneider, C. (1994) Parent-child Interaction: an
alternative approach to the management of children's language difficulties. Child l.ang1lage, Teaching and Therapy 1 (1).
Marson, S. (1990) Essentials of Management: Creating a Climate
for Learning. Nursing Times (86).RCSLT (1996) RCSLT Forums on 7ilwring for ExpeJiential Learing:
fillal report of the RCSLT Illitiative, 1995-6. London: Royal Collegeof Speech and Langauge Therapists.
Ward, S. (1992) The Predictive Validity and Accuracy of a Screening
Test for Language Delay and Auditory Perceptual Disorder.Ellropeall Joumlll of DisordeJ·s of Communiclltion 27.
Weitzman, E. (1992) Learnillg LlIllglwge and Loving It . Hanen
Centre Publication.
SPEECH & LANGUAGE THERAPY IN PRACTlCE WI! -ER 1997 15
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 18/32
••
- - - = = = = ~ = = ~ = - ~
SPECIAL FEATURE
2. Group placements with adults with a leaming disability
This project was concerned with fulfilling a genuine service needwhile offering a group placement for students in a spedalist area of
work, adult lea rning disability. The aims were to;
• provide clients with an appropriate service respons e to their com
munication need
• provide the four students concemed with an opportunity to
respo nd to a genuine referral from its o nset
• prepare the students for the particular nature of the placement
before starting
• give an opportunity for peer support in the group and in pairs.
In addition, it was possible to avoid one difficulty therapists in this
team had experienced; this placement was specifically desig ned for
a group of students who had requested to work with ad ults with
learning difficulties an d was offered in a block placemen t period
designated for adult work. When the focus of placements for a par
ticular year group had been work with children, students placedwith the team had viewed the placement at best as a welcome
alternative and at worst as a poor subsUtute for the unavailable core
placement.
I P r r Q ) ~ ® ~ ~Four third year students who had expressed an interest in working
with this client group attended a two-week group placement block
within the Speech and Language Therapy Learning Disability
Service, based in two multi-disciplinary teams. The students' main
focus was to work in pairs, following through two speech and lan
guage therapy referra Is.
In preparation for the placement, a college-based orientation ses
sion was jointly led by th e therapy tea m leader and th e co llege
placemen ts' coordinator. This session provided an opportunity for
the students con cerned to gain an overview of the placement and
to discuss th eir previous clinical experience and current skills and
needs. The aim was to prepare the group for the nature of the place
men t and to emp has ise the collaboration between the college and
the placement tea m. Th e responsib ility an d degree of student
autonomy in the programme was to be. balanced by a careful struc
ture for peer support , with group supervision by the therapy team
on a regu lar basis throughou t.
week-One• otlentation to location and timetable
1. Three clients had been referred from a local day se rvice and were
o n the speech and language therapy waiting list. Key workers had
requested an assessment of their communication with the aim of
identifYing strategies to support each client with a focus on group
dyn amics.
2. School pupils attending a Link Course at a local Further
Education Co llege required a communication screen to identifY
their needs and enable therapists to plan their provision for the
forthcoming full-time course.
[ E ~ ~ ~ ~ © l ~ ~ © 1 r UDuring the final feedback session the students listed the ski ll areas
in which they felt they had had an opportunity to deve lop:
1. int e ra cti o n skills with a new client group 2. observation
3. precise note tak ing and rep ort writing
4. gathering and pooling of informa tio n
5. developing a framework for screening and assessment
6. drawing conclusions
7. time management
8. collaboration
9. introducing self to staff an d clients
10. negotiating with staff
11. fitting into a Se rvice and team
12. independence and flexibility
13. evaluating own work and int eract ions
14. problem-solving sk ills for specinc situa tions, such as clients
absent during planned assessment tim e, general time constraints,
other priorities for staff and unpredictabl e events.
Each studen t was also asked to complete a detailed individual eval
uation of th ei r experience in thi s placement. All fo ur students list
ed a range of advan tages of this type of group pla cement, that is,
one with a specific task . From their evaluations, certain themes
emerged:
1. Peer placement offered support, shared knowledge and ideas,
reciprocal learning, a less daunting experience, "someone at your
•joint visits with speech and language therapists, meeting people who have alearning disability
• assessment workshop• meeting with other professionals based within the service• development of a screening assessment to be used with clients• discussion of strategies to use with clients/carers during the placement
Week Two
• visit to referral locations• presentation of draft assessment process to peers and then to therapists• completion of screening assessment
• analysis of assessment results• presentation of assessment results to peers and therapists• end of placement evaluation.
16 SPEECH & IANGUACL ·11-fERAPY IN PRACfICE WINTER 1997
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 19/32
SPECIAL FEATURE
Answers
A p a r t ~ n e r s h i p is required between education• • • • • •8 ...establishments, speech and language therapy service
managers and clinical tutors, providers of potential host
services and students; client consent is also needed.
M . . .U • .,NI Adequate orientation sessions, tutorials, telephonei M ~ , " • • •"1 access to tutors, video equipment, time with each. , .. . . M ~ other and protocols for self-assessment are required"!'I for maximum benefit.
~ _ Group placements develop team working, peersupport and confidence as a result of responsibilityM l w t W ! J . . ~ 1 or real-life problem-solving, can provide a service
in
under-resourced areas, and allow clinical supervisors
to concentrate on delegation and management.
own level ". Two students expressed a preference for peer place
ment, while the others found this "equally enjoyable" to an indi
vidual placement.
2. Group support from therapists provided useful direction, a
wider perspective, opportunity to question and helpful feedback in
a non-threatening context.
3. The single focus provided by the specific project was preferred by
three students and all felt they had the same opportunity to gain as
broad a pioture of the service as in other placements.
4. Support from UCL was seen as more indirect, but available when
required.
One student commented that potentially group placements might
give a less committed student the opportunity to opt out and rely
on peers, although this had not been a problem on this occasion.
All students questioned the necessity for the pre-placement
preparatory session, and in this respect (see below) this compo
nent was more beneficial to th e service than to the students.
l . The students were far more independent on a peer placement
compared with those on single placements because of the support
they were able to offer one another.
2. Support for the group from therapists was seen as time-effective
with the focus on facilitating the student team in problem-solving
and less need for didactic teaching.
3. The single focus provided by a specific project enabled an
increase in output from the service. Careful selection of referrals to
be followed through was seen as essential to the process.
4. The preparatory session, jointly led with the university depart
ment, focused the student group, gave recognition to the relevance
of the placement and accelerated the typical student adjustment
period for this area of work. Before this, the planning stage had
included a half-day workshop for the speech and language therapy
team, which renewed enthusiasm for student placements andenabled the staff to consider strategies for supporting a group
placement.
Group placements are not a new idea. They have been operated for
many years in university-based clinics, where the advantages are
acknowledged to be different types of learning opportunity, not
only an increase in available-placements. Service-based placements
can also offer this type of learning experience, with the same range
of specific advantages for the students involved. The focus on spe
cific projects allows the students to be seen (and to perceive them
selves) as a professional resource. All four students enjoyed and
learnt from the placement, an d three reported a particular interest
in working with the client group in the future. The speech and
language therapy team continue to offer peer placements and are
planning further group projects, and the UCL placements team
continue to be enthusiatic about group placements focused on a
real service need, as a basis for high quality learning opportunities
for students.
The authors
Ann Parker, Senior Lecturer in Professional Studies at the
Department of Human Communication Science, UCL wrote the
first paper with Keena Cummins, Principal Speech & Language
Therapist working in Parent/Child Interaction for Camden &
Islington Community NHS Trust and the second with Rachel
Farazmand . Therapy Team Leader with the Camden & IslingtonSpeech & Language Therapy Learning Disability Team.
Acknowledgments
The authors are grateful to Al ison Ruddock (Principal Officer for
Under Fives) and her colleagues, the Heads and Staff of the Under
Fives Centres and Further Education College and the Learning
Disability Service staff. Thanks also to our colleagues in Camden &
Islington, especially Sarah Hulme, Rob Spence, ClaireTopping, and
those at UCL, Myra Kersner, Rachel Rees and Maggie Vance. We
should also like to thank the families and clients concerned and the
students themselves, now qualified speech and language therapists.
Note
UCL's Department of Human Communication Science
would be interested to hear from any Speech and
Language Therapy Service Managers who would like to
develop similar projects with groups of students. Please
contact Ann Parker, Department of Human
Communication Science, Chandler House, 2 Wakefield
Street, London WClN IPG.
SPEECf-1 & LANGUAGE THERAPY IN PRACI'lCE WINTER 1997 17
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 20/32
COVER STORY
Memory involves all the
senses, but auditory
memory deficits have a
particular impact on
language development
given the transient,
sequential nature of the
spoken word.Here, Maggie Johnson
describes the approach
adopted at Gap House
School for addressing
auditory sequential
memory deficits in
children with a
developmental speech
and languagedisorder.
Lost•in a
movingstream -
audrtor.sequen lal
delerts
Memory is fundamental to the process of language acqui
sition and involves:
• immediate recall (shon term memory)
• recall of serially presented information (sequential
memory span)
• retention of information while processing and acting on it (work
ing memory)
• storage of information for future use (long-term memory)
Talking to parents
It is often difficult for parents to appreciate the difference betweenlistening memory, which is sequential, and visual or experiential
memory. Assessment findings may seem contradictory; "But he
remembered exactly where we used to collect conkers when we
went back five years later - he's got a better memory than me! ".
It is imponant to explain these differences early on in simple terms,
for in complex language disorders residual auditory memory
deficits are likely to persist into adult life. The Generation Game
conveyor-belt analogy is a useful one which captures the now-you
see-it-now-you-don't aspect of sequential memory - images which
seemed so clear a moment ago are quickly lost in the moving
stream of casseroles and cuddly toys ........ How much harder it
would be if you had to recaIJ those prizes in the same order as the)!
had appeared - yet in spoken language with its phonological,
morphological and syntactic sequences, that is exactly what is
required.It is also necessary to explain the difference between rote memory
which is generally associated with a good memory span but
requires no comprehension, and verbal memory of which compre
hension is a vital component. Most people can recall no more than
18 SPEECH & LANGUAGE Ti l ERAPY IN PRACTICE WINTER 1997
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 21/32
s ix
or seve n
words in
II. Long-term Memory
or many presentations.
(a)
Can you say that
again a bit at
a time please?
COVERSTO R
weakness (Fig.I) .
(ii) individual learning
(i ) direct work on extend
ing memory spa n / improv-
ing retention
(ii) classroom support
(iii) co mpensatory suategies.
At Gap House we tend not
to work directly on extend
ing auditory memory span
(i.e. gradually increasing
from two to three to four
items and so on) beyond
seven to eight years of age.
This is when basic auditory
memory span (as measured
by digit repetition) tends to
plateau, but verbal memory
(as measured by sentence
repetition) continues to
increase as the child's com
prehension and syntactic
ability improves. Instead,we concentrate on using
semantic organisation, visual
imagery and cueing strate
gies to improve retention of
verbal information, and
bu ld up co mpensatory
s:tTlIlegies to prepare chil-
dreJl for when they leave
the school.
l1 troughout their time at
Gap [ l ouse, children are
helped to recognise and
ac ept their problems. It
can make n enonnous dif-
ference to know they are
not gelling it wrong, they
simply ca nnot remember.
The focus is then on find-
ing a wa y round the diffi-
culty rather than feelings of
failure. All wo rk is done in
groups so that the children
can learn from and support
each uther. As a general
rule they are discouraged
sequence i f pre
sented randomly, bu t
they will manage 20
words perfectly, if pre
se nted in meaningful
sentence-form. Children
with comp rehension dis
orders do not have this
advantage and ca n there
fore hold very few ideasor key-words at anyo ne
time. They may have a
well developed rote-
memory for vocabulary
and sentence patterns
however, leading to com
paratively flu ent expres
sivelanguage .
This article will describe
the approach adopted by
therapists at Gap House
in addressing auditory
memory limitations.
The children are aged
between 5 and 11 years
and present with a range
of speciftc and comp lex
spee ch and language di s
orders. They fall within
the broadly average
range of ability overall.
Experience shows these
children are unlikely to
find a 'cure' for their
poor auditory sequential
memory. Our aim there
fore is to extend memory
span as far as possible
and then hei r develop
compensatory tech
niques which can be carried into adult life.
Assessment
Assessm en t will include
both formal and infor-
ni'al measures, and
involves identif ying:
(i ) areas of strength and
Figure 1: Assessment I Observation Checklist
Short-term auditory sequential memory - immediate recall for
spoken word.
(a) Digit Span, eg.3-5-1
(b) Word Lists . ego cup-horse-bike
(c)Sentence Repetition, egoThe dog barked at the cat.
- information is committed to memory after a few
Rote-sequences
• nursery rhymes, familiar slory
• days of week
• seasons
• months of year.
(b) Comprehension of rote-sequence
• answers questions about rhyme/story
• knows what day it is I what day comes after Thursday I
when goes swimming, etc.• knows which season their birthday I Christmas is, elc.
• knows what month it is I whose birthday comes first , etc.
III. Working Memory - continuation of short-term memory traces
while information is processed and acted on.
(a) Digits
• time-lapse, ego write down sequence of digits after 30 seconds
• mental arithmetic, ego write down digit plus 2 (i.e. I say 4, you
write down 6) .
(b) Words
• time lapse, ego Pass on 'shopping list' to person in next room
• time lapse plus distractors, ego Hunt through box for these 3 items ...
• syntactic processing, ego sentence formulation I narrative using
two to three stimulus words
• semantic processing, eg - Odd-Man-Out: which word doesn't belong?
(word relationships) - Similarities and Differences: how are
'orange' and 'apple' the same, and
how are they different?
(c) Sentences
• time lapse, ego "At the end of the session can you tell
Daniel it's his turn please?"
• verbal absurdities, ego say why sentence doesn't
make sense : " I kept my hands in my pocket and blew my nose."
• deductions, ego What Am I? (child uses three
clues to deduce answer)
• inference, i.e. Uses own knowledge to supply
missing information, ego "There was a loud
bang and glass in the road. What had
happened?"
strategies (Fig.2). hates the story-tapes we got for the ca r - from guessing unless the adult asks them
This seco nd aspect is parti cularly signifi- there are no pictures to follow ". to guess (they'll need to do th i s during for
cant for its implications in planning inter mal c1SS oss ment , for example). They learn
vention, and helps tu ex plain apparent dis Intervention it is mo re effective to say "I forgot what youcrepa ncies in performance. One parent said", ask for repeti ti on or seek confirma
com mented after di scussi ng her child's Intervention can be thought of in three tion ("Did you say .. . 7"). Conversational
;}SSE'SSmen t flDdings "S o that's why she main strands: repair of this type plays a large part in
SPEEC [ [ & lANCUAC E THERAPY [N PRACl'ICE W[NTER [99 7 19
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 22/32
COVER STORY
Sorry, I can't
remember
all that.
oping com-
pensatory strategies an d
this is documented in more
detail in "Functional Language
in th e Classroom" (FLIC) under
the chapter on Active Listening (Johnson,
1996),
Figures 3 and 4 outline the main tech-
niques used at Gap House,
especially the
Continued
needs to
way process
teachers
to check
standing
modify
delivery if neces
sary, an d
dren pr epa red
to let teache rs
know th ey are
having diffi-
culty,
children will
need confi-What next?dence to do
this howevOn leaving Gap Ho use, the children's par-
er, an d thisents an d receiving schools are providedinvo lv e swith an advice shee t on compensatorymo re th anstrategies (availabl e from AFASIC, Glossarya rm i n gSheet 26 ) . It is im perative tha t any resid-th e mual auditory memory limitations are recog-
~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ ~ - - - -Figure 3 : Intervention Strategies
Key Stage 1
STRATEGY
nised by all involved,
child ,
support
be a two-
with
preparedun de r-
an d
their
chil-
Figure 2 - Learning S
QUESTION trategies
Has Ch' lIdgo t ;sPo ken in ' ,mmedlateIs Child' ormation? recall far PROCESS
s memo ' A IIMPLmarginally i ry for lists of Udllory Me ICATION
tg, CUP-blue"troved by add70rds only C mary Span
,s Im medi Ig Vs. big_ b ng meanin? omprehe 'recall impro Iue-cup g , affeCting v e n ~ o n prOblems
What t IS presente If r al memoe f t e C t i / e ~ e of ViSUal su d VISually? ViSUal me ryC ' PPOrt i a man"
an child s mOst Pproach ' T , multi-sensa
Are lest malery Out a spoken ' Slfjning, sym ' ry
,Whl'e inslrUClnals available ,instrUC tion? ,v:rttten W0n:1 ChaOIS
, Picturess P IOns ' lOr s ' verb I ' rts '
, 9rtorrnanc , given? canning M a Compre" , COIourCOc/iChild has e e (,) better .. ay be USin 'ension ng
Instructlon/es Shut wh ile WO rse if (Chunk i n f o r m ~ t ~ / S u a l cUe to
en/ng 10 I eXlemaJ IOnso /m c!Jstraclors
Th e after tl/ne_l Out sPoke ma/en I ViS ualCan Child
carry
(ii) proved ab'l, remoVed,of was refiant on Iy to mentallse
task and s perform POOrl WOrking I'll
Does Child apSe? n InstrUction f o r m l i O ~ s to i n t e ~ n nalWayS ha lJddenly 'Click , toBI start ofthan Va to be d a task
emory
WOrking I'llCan expla in ed? emonslrated S
child h I rathe,emory
Order to dad verbalinformat ef/ve fUrther ormation Ino Ian Cre meaniOes Child a atlvely? ng I USe SemantiC I S
mformatlon . a beNer On ab prOCeSSing y,n/aCtic I Phonol '
(eg, can do preSented v aVe tasks If P Us WOrkin 0g,caJ
but not If h dd-Man-ou ISUally?ears WOrds) t IVlth Pictures So can C Working me
E/I/n ' g memoryinates
Of) oncentrat maryproceSSing e
EXAMPLES / COMMENTS
Basic listening / attention skills
Left to right (L -> R) sequencing
Basic auditory sequential memory span expansion using visual
memory reinforcement, increasing from1-4 items at child 's pace
Retention of sentence patterns using colour-coding as prompt
Rote-sequences / lines in play using motor-cue s (finger-spelling / Cued
Articulation / signing), visual support (pictures / symbols / words) or 'chaining '
Teach awareness that messages can 't always be understood.
Following spoken instructions - adult uses various suppor t strategies which children
learn to identify.
(i) non-fade prompts (pictures/symbols)
(ii) fade prompt (signing)
(iii) chunking' - use pausing to separate information into meaningful units for child
to absorb / visualise / act on before hearing next chunk
FOllowing spoken instructions - child employs various
strategies which they learn to identify.
(i) draws own pictures (need to identify key-words)
(ii) 'chunking' - pick ou t 3 words / ideas they have to remember
(iii) rehearsal (repeats key-words only)
(iv) rehearsal (sign and speech)
(v) rehearsal - is order important? Do they need to remember
actual sequence of words or key-words in an y order?
Clarification Strategies , ego ask for repetition / ask for Signing / say ' I can 't remember'
Gather children in a circle before presenting Class Instructions to whole group:
(i) children leave circle with non-fade prompt
(ii) children tell adult what they have to do before leaving
the circle. Adult repeats as necessary.
Circle Time:
(i) Newstime - all children primed to remembe r another child's news; later to
remember evervone's news(ii) Give all children a simple command, then see if they can
remember everyone else's, not their own!
Discrimination, location, selective listening,
"Good listening" from FLiC (see resources).
Provides visual framework for retaining
sequences of sounds / words.
Visual cues (to be gradually phased out):
pictures , symbols, signing.
Language Through Reading Colour Coding Scheme
(see resources)
Chaining: pictures in L -> R sequence , Cover first,say from memory and then 'read ' rest; cover firsttwo pictures, say from memory and then 'read' rest, etc .
ego Go to the bottom of page / and draw a circle
around / the jar with the most sweets.
eg oL - > R symbols on Flashcard
Key questions [When / Wh o / Where ?] to
structure narrative and aid recall. FLiC "organisation"
20 SPEECH & LANGUAGE TH ERAPY IN PRAGnCE WINTER 1997
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 23/32
Could you write
that down
for me please?
COVER STORY
Figure 4: Intervention Strategies
Key Stage 2
Clarification Strategies - gradually become more sophisticated
ego 'Can you say the last bit again please?'
Rehearsal
(i) introduce delay before children carry'out instruction (eg. wait for buzzer/run round playground/draw a house, first)(ii) give information which has to be retained until next day / next session / next week Combine with next two techniques
Visualisation techniques (Buzan, 1986)
(i) retaining list of items in correct order using multi-sensory ego if the first two items are 'red' and 'orange' start
imagery and thematic linking. Useful for lists such as planets in solar system. story off by imagining a ripe squashy tomato
crashing through the window and splatting you inthe face. You wash it off with ice-cold orange juice ..
(ii) retaining items from a shopping- list I key-words from astory / series of commands in correct order uS ing ' one's-a-bun" technique
Mnemonics - let children make their own up !
Chunking - children make up own rules for learning phone numbers 312653 = 3 - my age (12) - my door number (65) -3 again
Note-taking - children practise noting main pOints using symbols I Enquiry and Elimination games
drawings or written word to aid deductive reasoning Short StoriesVerbal Absurdities
Identikit descriptions.
Class Instruction - provide reminders and opportunity for using ego each child has personal timetable to fill inclarification strategies with week's events. Children have to let teacher
know if they get lost.
Preparation for leaving
(a) Personal Plan for most useful learning techniques and AFASIC Glossary Sheet 26.clarification strategies
(b) Advice sheet for parents / receiving school
Please say that
slowly while I
write it down.
strategies
adults in
their new school
Why do parents of'••lIllt can be difficult to separate out different aspects ofchildren with a language memory - auditory sequential, visual, experiential.
disorder often feel theI. . . . ~ r o t e , verbal - and realise which a child is using.
will need to give permission for the strate
gies to be used as appropriate.
Maggie Johnson is employed by Canterbury
and Thanet Community Healthcare Trust and
leads the Thanet Paediatric Speech and
Language Therapy Teqm. She is senior therapist
Questions
child has a good memory?
When should direct
intervention stop?
How can children behelped to understandtheir difficulty?
at Gap House, an L.E.A. primary school for
children with specific speech and language dis-
orders.
Acknowledgement
Grateful thanks to the Speech an d
Language Therapy Team at Gap House:
Caroline Emby, Julie Gore, Ruth Watsonan d Tracey Hull .
References
Buzan,T. (1986) Use Your Memory. BBC
Books, London.
Resources
AFASIC, 347 Central Markets, Smithfield,
London EC1A 9NH (0171-236-3632)
Johnson , M.(1996) Functional Language
in th e Classroom. Available from
Manchester Metropolitan University
(0161-247-6394) f7.25 inc. p & p.
As auditory memory span is unlikely to expand after achild is eight years old, any direct work should besupported by the group teaching of compensatory
nniques and advice to teachers.
e children have to recognise and accept they arenot
• ng, they simply cannot remember, then be confidentand prepared to seek specific help as required.
Language Through Reading, ICAN Book
sales ( 0 1 7 1 - 3 7 ~ - 4 4 2 2 ) . Passey, J.(1993) Cued Aniculation, Stass
Publications.
Canterbury & Thanet Verbal Reasoning
Skills Assessment Pack. Available from SLT
Dept, Kent & Canterbury Hospital, tel.
01227766877, f1 2 inc. p&p.
SPE EC If & lANGUAGE TlIERAPY IN PRACTICE WI NT ER 19 97 21
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 24/32
REVIEWS
NEUROANATOMY
Excellent illustrations, littleinformation
Brain Dissection and SurfaceAnatomy for Communication
Sciences
Douglas B. Webster
Singular
ISBN I 56593 855 0 {I 950
Thi s manual is designed to show the
3-D organisation of the brain with
particular emphasis on communica
tion disorders. The manual is divided
into two main sections.
The first, Surface Anatomy of the
Brain, gives an overview of the ma in
structures of the brain with accom
panying illustrations in the form of
labe lled black and white photographs.It describes the position of structu res
of the brain in relation to other struc
tures and occasionally mentions the
functions of these structures.
The second section, Dissection of
the Brain, describes how to go about
dissecting the brain to revea l it s
internal structure and organisation.
This section again contains many
photographs to illustrate structures
described in the text and show the
physical relationship of adjacent
structures. This part of the manual is
geared to hands-on dissection and
clearly describes the different partsand textures of the brain and how
best to remove 01- dissect t hem to
achieve the best resu lt.
The manual does provide excellent
illustrations of cerebrum, dien
cephalon, brainstem and cerebellum
but contains little or no information
about the function of these regions
of the brain or the structures con
tained within them. It makes only
fieeting· reference to the structures
involved in communication and
speech and spends as much time
discussing those involved with vis ionand sme ll.The manual may be a use
ful library resource for speech and
language therapy students studying
neuroanatomy but has little to offer
the practising therapist.
There are two vid eotapes (not avail
ab le for review) which go along with
this manual and are designed to show
the dissection of a human brain, with
voice-over explanations, demonstra
tions of techniques and structures and
close-up views. Th ese may again be of
most use to the student speech and
language therapist studying neu
roanatomy to show the brain and helpin the identification of rts structures,
Fiona Dennis is a speech & language
therapist at Dundee Royal Infirmary,
AAC
A must for every department
Handbook of Augmentative and
Alternative Communication
Sharon L. Glennon and Denise C. DeCoste
Singular
ISBNI-56593-684-1 {HOO
This new book written by Glennan and
DeCoste with contributions from other
authors provides an up to date extensive
review of the field of Augmentative and
A lternative Communication, It covers
most topics in depth starting from the his
to ry of the field, service del ivery models,
assessment techniques and use of MC
with a large variety of consumer groups,
Each chapter offers the reader a wealth
of information and th is reviewer foundquite a lo t of food for thought in each
and every chapter, For example, the idea
of expand ing the team concept from a
multidisciplinary team to a tru ly collabo
rative team w ill help in seeking to
improve our service to our consumers.
Glennan and DeCoste coin some new
phrases such as "arena" assessments but
the se are explained well. The second half
of the book is divided into consumer
groups and accompanied by case stories.
These cases, although at times long, are
well wr itten and convey the re ality of
implementing an MC system into a con
sumer's life , Account is taken throughoutof the views of many different profess ion
als and fami ly members and the concept
of "fami ly centred" services is introduced,
A few chapters and most of the appen
dix is geared for the American market
and, although interesting to note different
types of American legis lation and its
impact on the delivery ofMC systems , it
really is not very valuable to the UK pro
fessional. However,there is a useful list of
World Wide Web sites on disability an d
a few e-mail addresses of suppliers,
These will prove useful to those who
have access to the Internet.
This book is inva luab le for any profes
sional involved with Me. It is not an
introductory text and readers will need
to have som e knowledge of the fi eld
either through courses or other read ings
to get the full value from it It is a must
for every department, cen t re, or institu
tio n which has a consumer base using
Augmentative and Alternative
Communication strategies, This book is
tru ly a "handbook" of the fie ld of Me.
Thi s reviewer welcomes it who lehearted ly,
Debo rah Jans is Coordinator and Specialist
Speech and Language Therapist at
KEYCOMM-Lothian Com munication
Technology Service, 29 Bryson Rood,
Edinburgh EH I I I DY
AAC
Practical examples undermined
Literacy through Symbols: Improving Access for
Children and Adults
Detheridge, T and Detheridge, M. David Fulton Publishers ISBN 1-85346-483-X {13.99
This A4 paperback is packed with practical exam
ples collected by people who are rea l enthusiastsfor symbols. The book is well laid out and sign
posted with introductions and summaries t o each
chapter. and a w de margin contain ing headings.
There are use fu l addresses and lists of materials
and resource s at the back
I would be glad to have this book because it does
contain some interesting and useful information
but I do have some reservations about it The ti t le
makes no claim to other than literacy. yet a great
dea l of the text is tackling issues which are much
more to do with communication in a w ider sense .
Too many of the issues involved remain un spoken.
For a newcomer to symbols, it needs to be sup
ported by a framewo rk which takes into accountindividuals' differing levels of language abi lity. There
is a worrying lack of explicit attent ion to th is fac
tor: although the authors discuss whether or not
to use word-by-word sym bolisat ion or just to
symbolise key words, the issues they cover seem
to me to be politica l rather than to do with indi
vidual needs, For me, one of the most powerful
ways of helping som eone take a more active part
in communication is for communicative partners
to adapt to the person's level of understanding
why sho uld this be any less Important when lan
guage is being communicated through symbol s?
Yet we are presented w ith examples of symbol
use that to me seem dogmatic in their symbo l-for
every-word approach. For example, on page 9 1 we are shown an aide-memoire for a sw imming
kit, which is clearly a list, and wou ld be wr itten thus
by anybody who was writing It for themselves, yet
in the examp e it is presen ted as a full sentence,"In
yo ur sw imming bag you need: sw im suit, towel, tal
cu m and comb," with full text and every wo rd
symbolised: not only visua l clutter but lack of
attention to the message's real-life use .
The advantage s of the authors' use of practical
examp les was somewhat undermined for me by
the confusing range not only of different sym bol
systems but of the different sizes, clarity and qua ity
of the images. There are some quite ghastly
Blissymbols on page 10 and I hated the room labels
on page 40 which had all sorts of unnecessary com
plications in them. I think some ed itorial comment
from the authors here would have been welcome.
I reckon the book will be most seful for those
wo rki ng with ch ildren and youn people in educa
tion: those working with adults may find it less use
ful, as it does not really tackle the issues involved
in introduci ng symbols to he enviro nments of
adults whose educational history and commun ica
tive opportunit ies m y be very diverse.
Jennifer Re id is a sp ech on d language thempist with
Fife He al thcore currently lorklng with children with
speCiol nee ds in mains ream and special schoo ls.
Reviewsin
this issue were provided by thera-pists attending an RCSLT Scotland study day.
If you are interested in doing a review, contact
the Editor, 01569740348.
22 SPEEC H & LANGUAGE THERAPY IN PRACTICE WINTER 1997
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 25/32
REVlEWS
SENSORY MOTOR
DEVElOPMENTWell-presented andpractical
Sensory Motor Activities
for Early Development
Chia Swee Hong. Helen Gabnel
and Cathy St JohnWms/owISSN 0 86388 15 3 X £29.50
This is a pradical and ea sy to
read non-academic spu-al
bound book wrrrten by
Occupationa l Therap ists. tt
primarily targets the newly
qu ali fied therap ist and Cdl-er
For the purpose of review,
the book is divided into
three distinct sections.
Section I
Four chapters covering senso
ry and body awareness, basic
movement, hand skills and spa
t ial and ear ly perceptual skills.Each of these four ch apters
has a sma ll but concise intm-
duction defining normal
development and the difficul
ties which childl-en can face if
thiS area of development IS
delayed. The activities sug
ges ted for treatment are
pract ical and stimulat ing with
the materials required easily
accessible by al .
Section 2
This co ntain s twelve examples
of small group sessionsThe aim,
materials and development of
the sesSions are clearly defined
and pmvide an excellent pho
tocopiabie resource for a ther
apist imp lementing gmup work
lhemse lves or for other pmfes
sionals / carers to run.
Sect ion 3
This provides an alphabetical
subject resource list, eg ani
ma ls, clothing, shapes. Under
each of these subjects are
the foUl ' headings (as men
tioned in Sed:Jon I ) and
methods by whiCh specificaims can be achieved.
This book is wel l presented
both in layout and graphiCS
produci ng an Invaluable
resource for any therapist
work ing wi th children who
h(lllc spe ci fic diffic It ies in t he
areas Indicated above.Aileen Il/leForlane IS SeniorOccupouonol Th erapist - ChildHealth, Robert Henr-ysonSchool, Dunrerm lme. Fire
OUTCOME MEASURES
Simple, clear, demystifying
Therapy Outcome Measures - Speech and Language
TherapyPam Enderby, Alex John, Manno Sloane and Brion Petherhom
SingularISSN I 56593-807-0 £3350
Thel"apy Outcome Measures, (TOM) consists of two manuals:
the User Manual and theTe chnical Manual, plus laminated cards
of outcome measures fo r ten cl ient groups.
n) e ai l ) of the apprO< lch is to "assis l with the practical Imple
men anon of gathering outcome data on patients receiving
treatment' fOCUSing on the use of one tool to assess the
pa t ient and hiS/her neecs In a holistic way.
Even t h e r a fro fear die term 'outcome measure' cannot
fall t o app","clate the 5.1fT; :l"ar way the man uals are written
an d to ili lmediat ely see ho i 1hIS apprcach is directly applicab le
to a speech clnd language tJ- eraplst's .....-ark. It IS an important
step for the speech and language theraoy profession to have a
way of evaluating what therapIsts see the " Jcb €"tallfng allow
ing the clinician to evaluate the "quail 'o f care ~ n to dlents,
The Technical manual covel's various measun:s (L Tently avail
able to evaluate health status and goes on 0 e plain that traditionally therapists have measured change In speec ar'J lan
guage deficits on ly, although realising that thel"apy should have
an impact on many other areas of a client's life, As a result
TOM uses the parameters of impairment. disability, handicap.
(follow ingWHO International Classification) with the add lDon
of the pal ameter distress/wellbeing to refiect the multitude of
areas therapists are Involved with. TOM is based on the behef
that the above parameters are all of equal importance in ev al
uating therapy outcomes.
The Technical manual goes on to detai l t he development of the
outcome scales, the pilot study data collection . the reliability
and validity studies and outcome /·esults. The limitations of the
study are cleal' ly stated, (eg. sho rt time sca le for data collec
tion) as are the strength s.
One hundred and th il"ty two thera pists from eight sit es wereinvolved in developing measures I'elating to im pairment dis
ab il ity etc, after three hours of t l'aining. Data from 1, 17 1
patients from t he eight sites was an alysed and showed the
TOM approach as reliable (when bas ic t rain ing and practice is
given), val id and sensitive to cha nge .
Th e ia l-ge number of thel-a pists involved I-esulted in a common
language for the core rating scale; however the inclusion of a pri
mary core scale allows therapists in an area to devise specific
scales if necessary.
The core rating scales for each communication disordel- allows
scoring of 0.5 points, taking the basic 6-point scale to a possi
ble I I points, allOW ing a senS it ive I"ating scale.
The user manu al gives conCl"et e detai ls on the procedure for
usingTOM such as which pa t ients to use TOM with and prac
tice needed before.begin ning data collection.
As Enderby states, t rying to capture and refiect clin ical Judgement
is difficult however; this approach a lows for outcome measure
ment "i a practical , reliable. achievabl e and communicable way".
Every speech and language thera pist should have access to this
invaluable tool which demystifles outcome measures, making
what can often be a difficu lt procedure to approach and carry
out much easier It gives a sta rt ing point for each therapist or
depa rtment (if they haven't done so already) accu rately to
I"ecord Intervention.
Andrea Jones IS a Speech & Language Them 151 working WIth Adultswith Learning Dsabilities In Lanarksh ire Health Care NHSTrust
PHONOLOGY
Immense value
Children's Phonology
Sourcebook
Lesley Fynn and Gwen LClnCClsterWinslowISBN 086388 156 4 {J950
A photocopiable sourcebook of this
type is always a welcome addition to
any paediatric speech and language
therapy department where therapy
programmes and materials are con
stantly in demand. To be able to use
them as part of a parent programme
pack which enables parents to help
their own children who have phono
logical diffiCUlties, is of immense value.
The information pages within the
boo k en capsulate the advice given
to pal"ents on a one to one basis in
most speech and language therapy
clinics and as such co uld be used to
prOVide speech and language thelapyservice delivel"y In d iffe rent w ays, for
example as home progra mmes, in
ser ice t lalning to Nursery and
PrImary Sch ool teachers and, as in
our paedlatic department part of a
parent group programme fo r the
parents of ch ildren w fth phonological
dll'ficu "'tho are on th e waitmglist '0 1 therapy.
To support the ideas and thera py
matenals In their b...ook the authors
have given a I ide ovel iew of
resea l'ch evidence dealing Wth
phonological acqUisition at all levels of
inp ut and :;uggest a meaningful minima l CQ.1trast therapy and an audito ry
input app roach to Intervention.
They also underline, in chaptel' 7.
the impOl'tan ce of finding ways of
auditing the effectiveness of our
intervention st rat egJes and provide
a summary of studies comparing
the efficacy of different approaches
to phonological therapy.
The theoretical co mponents of this
book are useful but I have to say
that some of the technical ter-m in oJ
ogy use d (post vocalic obstruent;
canonica l shape) was difficultto
follow even for the IllOst recently
trained speech and language thera
pists in my department
Neverthe less , my view of thiS
sourcebook is a posrtJve one and Iwould recommend It as a use ful andinformat ive herapy resource.
Ma rgaret Sibbald IS 011e[SpecialiseSpeech & Language Therapis t(Paedlotfl(S) In the Monklands ICumbernauld DiviSion o( Lonarkshire
Heolthcare NH STrus t.
Note {rom Singulor Publishing re - Articula tion and Phono loglcol Disorders,by Ken Bleile, reViewed In the Aurvmn 97 Issue:
"This book is a second edi tion and does not replace , as the reV ieWE r Implies, Ken Bleile's other work. Manual ofArtlcuiatJOn andPhonologica l Disorde rs. Ra ther, this second edition has been rewi/teen to (ol/ow the JI;1onua('s format to enable users to work With bothtitles .As the reviewer nghtJy surmises, thi S book o( exeroses IS de signed (01 students, the tVlonual IS de51gned as a cllmcal reference(although it is widely adopted os a student textbook)."
SPEECH & L \N CLJ i\c r TllrcRAPY IN PR;\CTICE WI, I U( 1997 23
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 26/32
sounddifficulties
Speech and language therapists, given the case history
information opposite, set out their management of Mark.
Morag Ogilvie is a speech and language therapist
working with children in community clinics in Edinburgh.
At the time of writing, Rachel Osenton worked for
Thamesl ink Healthcare Services NHS Trust, but has since
become Rachel Stanbury and is a senior speech and
language therapist with Northern Devon
Healthcare NHS Trust.
Pam Williams, Juliette Corrin, Sarah J. Colebourne, Shula
Burrows andSarah Friel are the speech and language
therapy team at the Nuff ield Hear ing and Speech Centre,
Royal National Throat Nose 8 Ear Hospital, london. This
specialist centre offers assessment and treatment to
children with speech, language and hearing difficulties.
24 SPEECH ... LA. UAGE TI l ERAPY IN f'RACllCE WI ITER J997
MarkMark is eight when hemoves to your area. Thespeech anCilanguagethera)?y transfer recordsshow He was late to talkbut language de'!elol?mentwas age a p p r o p n a t ~ byfour years andl1eanng
difficulties have been ruledout He was in distress atbirth with the cord roundhis .1eck but generaldevelopmenThas beenunremarkable. Fromconversation and schoolprogress it is clear he is anIntelligent child. His olderbrother attended therapyfor a few phonolowcal .difficulties all of wf1ichwere sorted out by the timehe was six.Mark uses f for th andI for r. Therapy for initialstopping was successful but
he has persisting velarfronting (all worll positions).He is unable to producevelars even in isolation. Hismother reports hesometimes used to confusetlk/dlg when spellin butno longer does so. ark isco-operative and
motIVated to improve hisspeech but is becomingdespondent.
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 27/32
HOW I...
. . •onTom has a tongue which can bend to showfalveolar or velar placement. \Nhen Tom says aMorag Ogilvie chooses the Metaphon
Sick Children's back sound or a front sound for Mark to idenapproach to tackle Mark's diffirufties tify, Mark can see exactly what Tom's tongue isNHS Trustand ouUinesatherapy dream scenario - doing, while I express the action verbally
and the other one.
Welcome to Edinburgh, home of Metaphon , where clinics echo to
the sound of small children charging from the back to the front of
the room while blowing long/shon bla IS o n \\Oh i tJ (loudly or qui
etly), Metaphon therapy is my usual first cho ice or pho nologi cal
problems, but would I use a Metaphon approach with il. l, rk - do es
a child who can't say /k / at age eight have a phonologi cal pro lem'!
AssessmentMark and his Mum are offered a 45 minute appointment at his
local clinic. After some general chat and a history, I move on to
more formal assessment. In spite of some irritating features
we've coloured that pointy sun in yellow bu t they all still call it a
'star' - I find the Metaphon Screening Assessment gives a good
quick impression of a child 's phonological system, I never use thesummary sheets, bu t do sometimes use the process specific probes,
I also do a consonant imitation test and an oral exam , Mark has
good tongue movement an d no obvious abnormalities,
I'm interested in Mum 's report that Mark used to spell the way he
spoke, but can now spell properly. Does this mean his phonolog
ical representations are intact, or has he learned to compensate?
I'm interested, but not enough to investigate further at this point.
I succumb to the temptation to get on and do something,
Targeting therapyMark has two inappropriate phonological processes operating, We
should be able to sort ou t /r / -> /1/ without much trouble, which
would give Mark a feeling of achievement. However, he is more
conscious of the velar fronting, After all, he can't say his own
name, To help Mark have some control over his therapy, 1would
"Tom's tapping the top of his mouth with the
back of his tongue, He's making a back sound,"
When Mark has to take turns producing front or back phonemes,
he is still unable to produce /k/ or /g/, but I accept any 'back sound'
from his coughing/gagging repertoire,
We begin word-level activities using the pair tar/car (so the /k / will
be facilitated by an open vowel) and Mark sees the communicative
impact of a change in word initial phonemes, Week three there is
no clinic because the therapist has a meeting, When Mark returns
in week four, Eureka! - he can produce velars, Over the two weeks
so me thing has clicked and Mark is now able to raise the back of his
tongu e to command (honestly, this does happen), Now alongside
the /I..t tapho ll programme (example of game in figure 1), we play
velar-onl -games to encourage less effortful articulation, At the end
of eight weeks Mark is using velars in clinic tasks and when reading
aloud, He is put on review to be seen again in three months in theexpeoation that veJars will have transferred to his spontaneous speech,
The other scenarioIn spite of ou r best efforts , !lark shows no signs of velars, He needs
more help so he doesn't begin to feel a failure, Time for the
Tongue Gym, I explain to "lark that just as I can ' t do press-ups
(demonstration an d collapse) his lOngue muscles need some help
to make back sounds, He gets a tongue work-out sheet an d a chart
to keep a record of his practice (see Certificate of Achievement,
Figure 1), Metaphon aOivities continue, with me trying to shape
Mark's back sounds closer an d closer to velar placement. By the en d
of eight weeks Mark is producing an effortfu.l / k/ which he can use
in clinic tasks with a big gap (Mar - K), Mark is given a two month
break, and comes back showing little change, At this stage I would
consider targeting theask him which process he would prefer to tackle first.
Mark opts for the fronting, and he's offered a block of eight week
ly therapy sessions, At the en d we will take stock and decide what
should happen next: Because Mark is already self-conscious about
his speech, he gets on e of ou r precious after-school appointment
times so he is not embarrassed by being withdrawn from class, As
Mark has moved to a new school, I would want to liaise with his class
teacher so that s/he understood Mark's speech sound system and that
Mark could no t be expeoed to decode reading words accurately for
sound at this stage,
To Metaphon or not?In Mark's case there are three things
that would persuade me to go the
Metaphonway,1. Fronting is no t the only process
operating, This suggests a generally
delayed phonological system of which
fronting may be only a particularly firm
ly frozen part,
2, Mark seems a bright kid wh o should be
able to benefit from the opportunities
Metaphon therapy gives to reflect on his speech sound system,
3, Mark knows he "can't say" certain sounds, With Metaphon,
Mark will be able to experience success in his first few sessions of
therapy which wiII hopefully give him the confidence to persist if
things get a bit tricky,
The dream scenarioMark enjoys the Metaphon aCUvJlles and produces a series of
/r/->/I/ process so Mark
does not get too dis
couraged, When this
had resolved, we would
return to the velaI's for
more slow progress,
If Mark were to con-
Certificate of A C h i e v ~w. heRb) pro_,
, Mark's Tongue"'Jib Ibi, CcniIic.te '
IClIleY.melll i : ~ t : t : : : h l of ilS
Back Sounds
••""'"
Figure 2
coughing and gagging noises for 'back sounds', Because I know communication,
Mark is going 10 have problems making velars, at Phoneme Level,
I use Tom the cardboard crocodile to feed Mark very precise artic Reference
ulatory information about how the speech sounds are produced, Howard, J. & Dean, E, (1994) Treating Phonological Disorders in
SPEECH & Li\NGUi\GETHERAPY IN PRACTICE WINTER \997 25
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 28/32
HOWl . .
NORTHERN DEVON
healthcare_?_:w M iM !•••
on
Rachel Stanbury has tipsfor eliciting velars and suggestsan
intensive school holidaycourse of therapy.
Children. Whurr. London.
Following Mark's referraL he would
first be offered an init.ial assessment
appointment. The information
gained from this would be vital in
determining the management plan
an d the nature of any intervention
offered. The session would consist
basically of a case history taking
and an in-depth assessment of his
speech sound difficulties.
Given that the basic information
about Mark's early history is alreadyavailable, I would want some fur-
ther details regarding his therapy
thus far such as "Which approaches
have already been employed, in
what way and with how much suc
cess?" This information might come
from either Mark's parents, his pre
vious speech and language therapist or even from Mark himself.
While taking the case history, I would take note of any regional
accent used by Mark's parents and bear this in mind along with
the accent prevalent in th e area the family have recently moved
from. After alL it would nO l be appropriate to target the fjth
contrast if 'th' is no t used wi th in that accent .
During the se-h i tory taking, Mark' paren ts' level of concern
may become apparent.1
his is also going to be a considerat io n
when plan n ing the form of in tervention a it may affec t both
thei r auendan ce at the clinic and the amou nt o f support given
at home.
My assessment of Mark's speech would fOGI on ~ e v e r a l 'lsped.s
of speech production . Firstly, I m igh t ad m in ister the SfAP
( outh Tyne ide Asse.s!lmenl of Phonology; STASS Publkatlons)
10 give me an overview of his spont.1neous sp ech sound use,
albeit at tlle single word lewl. J would follow tbis by looking at
Mark's ph on o logical awarenes with regard to the s o u l l d ~ with
wh ich he has di fficu lty. l'his could involve several differen t tasks
such as:
• discrimillillion between the ounds leg L/r) ill iso lation
• dis rimination between the sound s in word in itia l position
• right / wrong judgements from my produ ction , eg I would say
'Iabbit' and ask Mark is I h ad pronounced the word correctly
• silent sorti ng, eg Mark would have d seledion of pictures
, ." ' " " " ~ 6 Aspecialist op'
beginning with T and 'r' and he would
sort them according to what he
believed the initial sound to be.
This would be an important part of the
assessment because, if there is a problem
at this leveL work on speech production
alone is no t going to be effective.
Finally, I would try some elicitation of
the problem sounds. For the sound jk j for example, this could
include using his finger to hold down the front of his tongue
while he attempts the sound. Alternatively, he may be able to
produce a velar fricative from which the plosive might be elicit
ed. A third strategy would be to try and develop tbe sound from
the velar nasal which most children use even if they do not use
jk.gf. This would be by asking Mark to produce an extended 'ng'
sound holding his nose part way through to build up the intra
oral air pressure and this release an oral velar plosive.
Having completed t.he case-history taking and assessment, I
would then formulate a management plan with the parents and
Mark. It is very important at this stage that all parties are happy
with the final plan as the motivation and cooperation of everyone is needed. A number of factors would now need to be con
sidered. These include:
I. Mark's age and the fact he is at school full time.
II. The availability of parents and/or others both to bring ,"lark
to the clinic and to work with him between sessions.
III. The outcome of the assessment and elicitation.
One option which I feel might be very suitable for Mark is a
block of intensive therapy. This could be arranged within the
school holidays thus avoiding the problem of missing school. It
ma y also be easier to maintain Mark's motivation over the
course of on e week rather than several. The block would consist
of on e session every d ay for a week with each session lruillng 45
mi nutes to an ho u r and with rein forcement activities to be car
ried ou t ill home.. The aims and content of the block wou ld be
determined by the outcom e of th e asses ment but I would liketo target the /k,g/ sOllnds for speerh soun d productio n if at all
possible du e 10 their high frequency. Soun d discrimination and
phoneme awareneSl> work co uld covcr a broader ran ge or co n
trasts.
Each session would ind ude bOlh work on chscrimimllion Ol nd pro
duction and would p r o g r e s s ~ · tem atic.ll ly from the single sound
level througb the word level JOlI unto SC'ntence level and generali
a tion . '[he follow-up aruvities lor each day w mid be aimed at
consolidating the skills achic\'ed during that day's session.
Finally, I would follow up the block with a report to Mark's
s hoo l and if possible a telephone call to outl ine the in pu t he
had received, his current presentation in U! mlS of speech and
any ways in \,'hich further progress could be encouraged in
school. Mark's parents would also be advised on how to co ntin
ue some work with him at ho me and a review appointment
would be planned .
nTherapists at the Nuffield use in-depth
! assessment to ensure targeted treatmentand rapid progress.";
vVe were pleased to
receive a referral for
'Mark from his GP
in his new locality. The referral was instigated by
bis current speech and language therapist who had
seen him once and, in the I ght of his transfer records, had decided
she would like an opinion from a specialist centre on Mark's CUf
26 SPEECH & LAN GUAGE TJ-JERAPY IN PRACI'JCE WINTER J997
rent presentation and future management. It was very helpful to
receive copies of speech and language therapy reports and school
progress reports.
After approximately three months on ou r waiting list, Mark was
offered a co-ordinated appointment, seeing on e of the speech and
language therapists in th e morning and the Consultant
Paediatrician in the afternoon.
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 29/32
HOW!. ..
AssessmentThe speech and language
vides visual feedback of
tongue-palate contact. It
therapist carried ou t a
detailed three hour diag
nostic assessment with
Mark's parents present. During the session, the therapist first took a
case history involving information from both I\ lar k and his parents.
Then a detailed assessment batterv was ad m inis tered. In the light of
Mark's ongoing speech diffi cu lties an d h i, his to r;. of lan guage an d
spelling difficulties, it was felt ap propriate at thi s stage to rc -;mess
his language functioning, h.is re ad ing and spelling level s ,md h is
phonological awareness skills in addition to h is sp eec h sk ills. -Ihe
following formal an d informal assessments wne administered:
1. Language Assessments
British Picture Vocabulary Scale (Dunn, Dunn, Whetton an d Pint ilie)
Clinical Evaluation of Language Fundamentals I1evised (Semel, W ii g,
Secord)
Renfrew Word Finding Vocabulary Scale
2. Literacy Assessments
Schonell Graded Word Reading Test
Neale Analysis of Reading Ability Scales
Vernon Graded Spelling Test
Assessment of Phoneme/Grapheme knowledge
3. Psycholinguistic Assessment of Mark's speech difficulties, inves
tigating his processing at input, internal representation and output
levels.
a) Input tasks, ego • auditory disu-imination of complex non-words
• auditory non-word rhyme detection
b) Tasks involving internal representation
• real-word rhyme detection
• lexical decision
• sound blending
• syllable identification
• rhyme string production
• alliteration string production
• spoonerisms
c) Output tasks, eg .• spontaneous speech sample
• NuffIeld Dyspraxia Programme Assessment,
which investigates:
• oro motor movements
• single sound production
• single sound sequencing
• naming an d repetition of single
words (at ev, ev ,evev, eeveand multisyllabic levels) an d
phrases an d sentences
• Repetition of non-words
FindingsEvaluation of the assessment battery revealed Mark's primary area
of difficulty now is with speech output. Al though h e may well have
experienced input difficulties in the past (which would have affect
ed the precision of his phonological representations of some
sounds), evaluation of his input processing, phonological aware
ness an d spelling skills suggested th ese difficulties ha d largely been
overcome. In terms of output, his use o f I f/ for <th> was attributed
mainly to local accent an d therefore did not wa rrant inte rvention.
However, he was unable to produce /k/, /g! an d I r! sounds even in
isolation. He also appeared to have poor kinaesthetic awareness of
his lips an d tongue, although he had 110 obvious oromoto r dys
function an d no structural or organic diftlculties.
RecommendationsIn the light of Mark's speech profile, age an d apparent resistance to
conventional therapy, it was felt that he would be suitable for thff
apy using electro palatography (EPC). EPG is a technique that pro -
involves the wearing of an
individually-made artificial
plate (similar to a remov
able orthodontic appliance), which has 62 electrodes embedded in
its surface. As the tongue touches th e electrodes they create a two
dimensional display on a computer screen. In this way, the wearer
receives immediate visual and kinaesthetic feedback of the position
of the tongue. This technique is particularly helpful for older chil
dren, as it offers an added dimension to articulatory therapy.
It was decided to offer Mark a course of ten weekly one-hour ther
apy sessions which would include the use of EPG an d other tech
n iques . A report was written detailing all the assessment results an d
recom m end ations and was sent to both his local speech an d lan
guage the rap ist an d school. His local therapist was invited to visit
lh Olre to beco me acquainted with the EPG approach. A dental
examinalion was ar ranged for Mark, which involved the taking of
den ta l impr io ns of th e upper and lower teeth. These plaster casts
were necessary for the manufacture of the EPG plate, which took
approxim a tely an e month .On ce I\ \ark's pl a te ...."ali recejwd an d fitted, a detailed speech exam
ination Llsin g Ere \ -as ca rried o u t. This re\'ealed that Mark was
using a double a rticula tion for lh e p roduction of velar sounds but
ha d a normal pattern for the prod u ction of alveolar sounds.
Although he incorporated ve.lar co ntact into his articulatory pat
tern, the release of th e plosi \'e occurred in the alveolar position. He
was registering an articulato ry co ntrast fo r /tl a nd / k/ but without
the necessary acoustic differences - he nce he had a primary pho
netic problem with phonologica l impl ia ltjons.
ATTENTION-DEFICIT / HYPERACTIVITY
DISORDER (ADfHD)
AD/HD'98 - University of CambridgeWe ar c pleased to announce ADfHD'98. a four-day residential
conferencc at the University of Cambridge. 6th - 9th April. 1998.
International key speakers inelude Prof. Russell Barkley, Dr Tom
Brown. Dr Michael Goldstein, Dr Sam Goldstein. Prof. Philip
Graham (Chair of the National Children's Bureau). Prof. Peter Hill
and Prof. Mel Levine.
Papers. symposia an d posters ar e inyited,
An Intensive Training Day for Health and Education
Professionals on ADfHD
Speaker: Je nny Lyon, Chartered Educational Psycho logi t (f I 00 plus VA T, including course pack / text book and buffet lunch)
University of Manchester - 7th November
Charing Cross Medical School, London - 5th December
Napier University, Edinburgh - 6th February 1998
John Moores University, Livcrpool- 2nd March
A list of audio/video recordings from ADfHD'97 (held a t L ni vc rs it\ of
Oxford. 7th - 9th April. 1997), is now available on requ t. utge th er
with the official conference publication (published a t £16. in d ud in "
postage, softbound - ISBN I 901906000)
Further details ar e available from Angela Ra nde ll
IPS (International P sy choI\tg) Sen;ces)
Freepost SEA 1132 (no UK po s tage r equir d)
17 High Street. Hurstpicrpoin t, W est Sus se 8 !\ 6 9STelephone 012i3 835533 Facsimile 012 3833250
SPEECH & lANCUACE TIIERAI'Y IN PR. Cl IC[ IV tNH R 199 7 27
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 30/32
NEWS &> EVENTS
TherapyMark's therapy concen-
trated on
1. identification an d
perception of the differ-
ences between the adult
model production of
aJveolar and velar
sounds , in isolation and
in word positions.
2. production of velar
sounds, in isolation and
then in word positions.
Mark's therapy was sup-
ported by th e use of
lhree complementaty
approach es:
(1) EPG palterns
(2) pictorial symbols
for speech sounds and
minimal pair pictures atCV, CVC and CVCV lev-
els from the Nuffteld
Dyspraxia Programme
and
(3) alphabet letters.
Once Mark was able to
produce a velar sound,
he was given 'home-
work' of picture materi-
als to support his thera-
py in between his ses-
sions.
Practical points1. For an older child, after-school or intensive summerholiday appointments can be offered to lessenembarrassment about therapy attendance.2. Work on speech production may not be enough andassessment and therapy must identify and address anyinput and internal representation problems too.3. The opinion, age and accent of the child, frequency of asound and perceived ease of remediation will all influencethe decision about which sound to work on first.4. Elicitation techniques for velar plosives include use of apuppet to demonstrate positioning, a finger to hold downthe front of the tongue and working from strengths, eg a
velar fricative or nasal, or coughing I gagging.5. Preferred assessment and therapy techniques includeideas from Metaphon, Nuffield and psycholinguistic theory.6. With an older child, the primary work will be with thechild, but parental support and an understanding class
teacher influence attendance, home practice and outcome.7. If instrumentation is available, electropalatography canbe motivating and informative.8. If progress is not good, referral to a specialist centreshould be considered if possible.
Mark made rapid progress
and was soon able to pro-
duce Ikl as a single sound
and gradually in word posi-
tions. He also soon gener-
alised his new articulation to
Igj. Mark was delighted with
his ow n success and was
motivated to go on to work
on establishing Ir/. Using
EPG , he was able to identify
his articulatory confusions
wilh III and the Irl sound was
rapidly incorporated into
simple CV and CVC words.
The remaining sessions were
spent consolidating work at
phrase and sentence level.
ReferencesConnery, Y.M. et al (1992)
Nuffteld Centre Dyspraxia
Programme. London: Rt'lTNE
Hospital.
Hardcastle, W., Jones, W.
(1974) Electropalatography -
Reading IBM System.
Stackhouse, J. an d Wells, B.
(1993) Psycholinguistic
assessment of developmental
speech disorders. European
Journal of Disorders of
Communication. 28 (4).
RESOURCE UPDATE. . .RESOURCE UPDATE.. . .RESOURCE UPDATE.. .
Voice careThe Voice Care Network, a national
group of speech and language
therapists and specialist voice
teachers , continues to press for voice
awareness training in initial teacher
training. The Network provides
workshops and advice packs (see
examples below).
Roz Comins, Network coordinator,
welcomes information from DynaMytespeech and language A small augmentativetherapists on numbers of communication device suitableteachers on their for ambulant users is now availablecaseload (new from Dynamic Abilities.referrals, current The DynaMyte, a smaller version of thetreatment, review). DynaVox 2/ 2(, is suitable for.all ages.•.voice and the Software includes a concept associatedTeacher pack, £12.00 42000 word prediction and search capability,
(payable to Voice reinforced by 2600 visual symbols. Both
Care network) can be personalised and messages can beprinted. A long life battery, protective
with a Warm-up on screen cover and a rubberised case
Audio Cassette, £5.50
• Keep in Good Voice
with shoulder strap and handle are
(payable to Roz Comins). provided. Details / demonstrations:Dynamic Abilities, tel.Details andfull publications list:
07202487878.Roz Comins, Voice Care Network, 29 Southbank Road,
Kenilworth ev8 7LA, tel. 07926852933.
28 SPEECH & LANGUAGETH ERAPY IN PRACf ICE ~ V l N 1997
Led"amb,ml"ity' t ' ,lsa lrammg
AforU1coming training pack is
aimed at helping staff workingwith people with learning dis-
abilities on parenting.First Steps to Parenthood(£55.00) includes struduredinterview sessions to help staffassess the knowledge andrequirements Of their clients at
different stages Of parenting.Details of his and othertraining resources fram:Pavilion Publishing, tel. 07273
623222, W'NWpavpub.com.
Nursery ProjectsA new bi-monthly magaZinededicated to under fives educa-
tion has been launched byScholastic.Nursery Projects includes
adion rhyme and role playideas, photocopiable adivitysheets, advice on planningthemes and information on the
latest nursery resources.
Details: Scholastic Magazines,
tel. 07926876250.
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 31/32
EVENTS University of East AngliaPostgraduate Courses
January
Aphasia Therapy - A State ofthe Art
Tutors: various Fee : £95
February
The Lidcombe Programme
of Early Stuttering
Intervention5 days - details on request
9-10 March
Communication in Children
with a Severe Visual
Impairment
Tutor: Ian Bell Fee : £95
Venue: University of East
Anglia , NorwichDetails: Sally Wynne, Course
Co -ordinator, ContinuingVocational Education Office,
The Registry, University of
East Anglia, FREEPOST,Norwich NR4 7BR.
SPRING '98 published23 Feb 1998
IN FlffiJRE ISSUES
•working with parents• integration
•family therapy
• Retfs Syndrome
•aphasia group therapy
•working with carers (AID)
A Singular offer with your
clinical companion ... until
31 /1/98, new subscribers toSpeech & language Therapy
in Practice are entitled to a£10 voucher towards their
next purchase from Singular
Publishing. Singular has
kindly extended this offer to
existing subscribers. VOUChers are available
following application to: Avril Nicoll,
Publisher,
Speech & language
Therapy in Practice, FREEPOST S(02255
STONEHAVEN
AB393ZL
tel/ fax 01569 740348,
e-mail [email protected].
7/28/2019 Speech & Language Therapy in Practice, Winter 1997
http://slidepdf.com/reader/full/speech-language-therapy-in-practice-winter-1997 32/32
6. Photographs
Although there are manbenefited greatly fro m .. e a ~ ~ O d commercially available h~ ~ ' ~ ~ I : ~ I ~ ~ ~ i ' ' h ~ d , ! , ~ ~ ~ ' : : : h : h : f , : : 7 , m ' ; ' ' ' ; , ~ ~ o ~ ~ ; ~ ~ ~ ; , , ~ ~ ~ ~ ~ " ~ h " l t group
' ,"od,a0'1' ,'cd; " , 'd" ,', pho,o, h". b . wo '"p'" of , , 'h phoro . " '0 ,ookgames, I.e . hello songs. een used every session in were mounted on
BlanketO . .S activity Th
ouraged to r . e child islift the eled on the blanket, and two
d n sand ge I .e to side. Thl nt y sWing from. . s encourages ' .
. 10lnt attentioncommunlca . T '
. tlon. his is par-
I ren who are d'ffj I 109 non-verbal'ld lor motlvat'
d I ICU t to enun this activity gage.We haved non-verbal co e n c o ~ r a g e s both verbal
I mmunlcat' .ready steady gol and Id lon In responseI I d own/. Children
! go an lagain, again .....
a v i : g d ~ ~ a m / gluck
Ulerapists ce fromactivities A,we have i n t r o ~ C C U P a t i o
sk'ills ong With encou u ~ e d these I
....... It gives h' raging PI" I:"7 to part ie' c Ildren th e- io... nlch som Ipate in ta e °PPO rru
tendy e children ' ctile activo -aVoid Ch ' In the gr 'tieso t h e ~ Ildren are oups coosls_
SO th s play if th encouragedems elves ey are not k tofoam ' . een to
t IS spray dray. Gluck . e Onto aconsists of IS made in a sh IItable orto Corntlo a ow r .-
a smooth b ur and cold -. . ,.se t in th Ut solid waterup will e tray, but wh paste. It w/f
Thseem t" en mo·- '"
is is oft 0 melt" . ....of ou en used i and ue,co,'nA.,.
.- ••- - r faVOUrite st r n nurseries andS:ch as plastic relievers!
re prOvide utlery andfor " d. Thes .
child W h ~ ~ / t a t i o n as w:" gIVe
I shaving (. IS reluctant t ast t 1 J l .. r oam to b ' 0 touchegm exploring
See h - : ; ; - : ~ - ......t rougihplay balls / ..
" . b • _OH<' """d " """ p',ddp,b"' I" <h. "o,p. C"'" ," " ' " ,. . . .d ' " ........ die~ w o r d s__ of chei' , , , ' " ' , . "d '" "" ,b , I" , Imm.dl," CO ,h . wk ." ' " won!, . . . """"" . . . . . -..- '" "'e dlon< ,co,p ,nd """,1" wl,h ,p,,\fi, .mph"" 0 ' ,ho," won!, , , , ,d" homO,
,,!uP, bo1d Ion<"" "Iett.d"d ,'n,l. won!,,.d ph"'" we" p,I,,,d, m",meed and Jom\IWOI'II
Oft <ani, Th<oe wo,d, w ." ,ho"n pO' "b"" , .d ,Iott.d Inco d. .' pi""' pod<.u on AS ",,,s.
Th'" we" pl".d on ." w,\I b, " ,h ,ttl,l" '0' " f . " ' " by "'-.u..on4repetition of these key words was enc:ouraaed
Debbie Wilcox and Sar e speech and I arah-Jane BurnsAnita Mcfadze anguage therapists and
an a spee htherapy assistant with language
Children's NHS lim urgh Sickrust.
These resources are in rout-patient clinic at the Regular use in an
Ch ildren in Edinbur h h oyal Hospita l Jor Sickweekly basis. The g w ere groups are run on a
d
groups are staffi d by
an language thera . e two speechassistant. Althou h plSts and a multi-talented
different levels t ~ e s e w run groups JOT children atr. , r esources ar d 'JOT early communicat ' e use pnmarily
IOn groups k'carers and their ch'ld WOT Ing with
Th ese children are at a I rentheir development and m :e- lzngu lstlc stage In
children present h ny are non-verbal Th ed ffi wit varying d
1 lCUItY, autISm spe f I egrees oj learningd I ,Cl lC angu d
eve opmental dela 1 S age lSorder andd' . orne have bWgnOSIS and reqUIre not een gIVen a
Carers attend WIth the cha
penod oj assessment.actwitles TherapIsts Ihldren and work through
are t ere to dreqUIred. Groups b a VIse / model If
I d egln and e d . he acttVl ttes, eg, hello son n WIt th erapISt
We hope you Jind some oj mde game/ Singing.have as mu ch Jun ese Ideas useful and
as we do uSing th em.
during activities.
bubbles
pop
again
(name's turn)
ready, steady, go.
stop
9. MUsical taThe ins . pe for bodcom ~ / r a t i o n fo yawareness
· merclally r theIt was too 10 available LOA tape Was froto make ng for our c/' tape.Whilst m the
. Our 0 lent excellenJoyabl Wn . The . group and ent.The a e and with d fjmuslc had to b We deCidedand r SSIstant chose efjm/te rhythms e very simple
ecorded Ive si ' .lng the ins these played mple pieces of
each piece trumental and a keyboard ~ U S i cWe ch . r ythmieal ffi' c ang
• rock the followin e ects for
• sw . ogether g movement .109 arm • s.
• b s move fjru hand Ingers
Ths tog th • stam '
e childr e er p leet.
to c en Werea opy or obser encOUraged bIfproximate/y f j v ~ e the actions. T{ their ca rers
you can't play mmutes. IS tape lasted
teer. If no Yourself e .available o n t , ~ ~ r e is P l e ' n ; " s ~ a willing vo/uto the th / tape. 1m 0 fantastic mmarching ; ; :e music f r o ~ g l ~ e rocking ~ : : cStripes" _ I a band play ' The Piano" y
et your ' Ing "Th orImagination e Stars and
go!
Ji(t,alIab\e from Nottingham Rehab, ref L II I, £. I05 .~ e version was just under £20. Firstly you must decide on the largest s\J.e SW_·'. . . . child. . . and " ,. '1"" In ,h . dlnl', S"I. 0" , . ' " . , ' ,,,on!'ngiy. Fo' 0", dink
the triangular template to cut ou t 12 separate sections. We used cheap lining m:I.tIll'\al..bl lit.1: ,G. . . . . . was 3 metres.
quor., "",."'1 will ,,,,,d 'P co mo'" w"" "d " " .Th.lOO, ,;d" on ,\11,' -......... ,".,.,",,,,,,h Seam" fo, ,,,,,n,,,,.Th. m,,,n,1 " <h. " " " " of ....
rom Step B Jingling pIag Estate Yo y Step Ltd L y ball
200, ref pp ' ate, Bristol ' avenham Rdlarge i 5098, £ I3 95 Bs 17 5QX • Beechessmall c e.ar ball (50' ex VAT. ' tel. 0/454
_ ... . . _ " ' heavy, so cut ou t a small circle in the centre ofthe parachute about 15 cm in diameter and replace
vftth twO larger circles of material sewn on either
side.Tum under edges and hem.This can be as easy or
c.ornpIlcated as you like, using many colours, fewer sec