Problem solving in small multidisciplinary teams: a means of improving the quality of the communication environment for people with profound learning disability

Nurses and speech and language therapists who work with adults with profound learning disabilities frequently experience difficulties with mutual interprofessional role expectations. These stresses arise because of the unique fluid and temporal nature of the multidisciplinary teams in day care settings. The unit in which the present project occurred was very successful in attracting community visitors. A previously identified problem was the effect that these visitors had on the continuity of the communication environment. The pilot project had shown that the staff team needed to identify a method of effectively sharing information about communication. The nurses, and the speech and language therapist used this problem as a team development exercise. It defined the roles of the team members, explored their knowledge and skills, and developed mutual respect between the different professions. The present study describes both how the solution to the problem was identified, and how it developed the team and the individual's knowledge and respect for their different roles.     

Perspectives on public awareness of stroke and aphasia among Turkish patients in a neurology unit

Recent studies on awareness have drawn attention to the fact that aphasia is a little known disorder to the public, in spite of all the publicity about this frequently occurring neurogenic language disorder. Being a very new concept, studies of awareness are rare in Turkey. This survey study assessed the extent of public awareness of neurological disorders, including aphasia, and information sources to answer questions about such disorders. A survey questionnaire consisting of 22 brief questions divided into three sections of awareness was administered to a convenience sample of 196 adults at a University Hospital in 2004. The results indicated that epilepsy and dementia are "the most well-known", and Multiple Sclerosis (MS) is "the least-known" among the surveyed diseases/disorders. Aphasia awareness was also low. The respondents preferred doctors as the most reliable information source. Speech and language therapists were found to be one of the information sources in advocating publicity as well. Most respondents expected to receive information from the doctors; who, in Turkey, are totally occupied with the physical aspects of health care provision. Neurologists, in collaboration with speech and language therapists, should be in a position to develop educational programmes to increase public awareness.     

Collaborative participation in aphasic word searching: comparison between significant others and speech and language therapists

Background: Searching for words is a common phenomenon in conversations of people with aphasia. When searching for a word the speaker interrupts the emerging conversational turn with a pause, vocalisation (e.g., uh), and/or a question (e.g., what is it). Previous studies suggest that gazing and pointing can be used to invite conversational partners to join the search.

Aims: This study compares the collaborative actions of different conversational partners of people with aphasia (significant others vs. speech and language therapists) during aphasic word searching. The aphasic speakers’ actions inviting assistance from the partners in the search are also examined.

Methods & Procedures: The data for the study comprised 20 conversations, half videotaped at the participants’ homes and half in aphasia therapy sessions. The conversations were transcribed and analysed sequentially with a special emphasis on taking non-verbal actions into account. In the analysis, word search sequences were identified and the collaborative participation of the significant others, as well as the speech and language therapists, compared.

Outcomes & Results: The analysis showed that institutional and non-institutional conversational partners collaborate in different ways during word searching. When invited to join the search, often non-verbally, the significant others quickly offer words for the aphasic speakers to complete the search. When successful, these immediate completions solve the search and the core conversation can continue. On the other hand, even if invited non-verbally, speech and language therapists do not join in searching by offering words. Instead, they ask questions or offer their candidate understandings that are more elaborate than one word. Furthermore, they regularly shift the speaking turn back to the aphasic speaker encouraging the aphasic speaker to continue the search by him or herself.

Conclusions: The institutional and everyday practices of sequential resolutions of word searching differ to a great extent. Everyday conversational practices of collaborative completion appear more effective in solving the search and allow the aphasic speaker to experience smoothly flowing conversational interaction. Everyday practices could also be systematically used within aphasia therapy. Furthermore, if necessary, speech and language therapists should promote the use of these practices within daily interactions of the aphasic clients and their significant others.     

Perspectives on public awareness of stroke and aphasia among Turkish patients in a neurology unit

Recent studies on awareness have drawn attention to the fact that aphasia is a little known disorder to the public, in spite of all the publicity about this frequently occurring neurogenic language disorder. Being a very new concept, studies of awareness are rare in Turkey. This survey study assessed the extent of public awareness of neurological disorders, including aphasia, and information sources to answer questions about such disorders. A survey questionnaire consisting of 22 brief questions divided into three sections of awareness was administered to a convenience sample of 196 adults at a University Hospital in 2004. The results indicated that epilepsy and dementia are “the most well‐known”, and Multiple Sclerosis (MS) is “the least‐known” among the surveyed diseases/disorders. Aphasia awareness was also low. The respondents preferred doctors as the most reliable information source. Speech and language therapists were found to be one of the information sources in advocating publicity as well. Most respondents expected to receive information from the doctors; who, in Turkey, are totally occupied with the physical aspects of health care provision. Neurologists, in collaboration with speech and language therapists, should be in a position to develop educational programmes to increase public awareness.     

Qualifying language disorders of schizophrenia through the speech therapists' assessment

This study investigates a comprehensive assessment of language disorders in order to identify impaired and unaffected language abilities of individuals with schizophrenia. Furthermore, the purpose of this study was to demonstrate the importance of the role of speech therapists in the treatment of schizophrenia. Speech therapy is especially thought to treat language disorders. However, to date, speech therapists have not been solicited in the treatment of schizophrenia, despite growing evidence supporting that schizophrenia is characterized by cognitive disorders such as impairments in memory, attention, executive functioning and language. In this article, we discuss the fact that elements of language and cognition are interactively affected and that cognition influences language. We then demonstrate that language impairments can be treated in the same way as neurological language impairments (cerebrovascular disease, brain injury), in order to reduce their functional outcome. Schizophrenia affects the pragmatic component of language with a major negative outcome in daily living skills [Champagne M, Stip E, Joanette Y. Social cognition deficit in schizophrenia: accounting for pragmatic deficits in communication abilities? Curr Psychiatry Rev:2006;(2):309-315]. The results of our comprehensive assessment also provide a basis for the design of a care plan. For this, subjects with schizophrenia were examined for language comprehension and language production with a focus on pragmatic abilities. In neurology, standardized tests are available that have been designed specifically to assess language functions. However, no such tests are available in psychiatry, so we gathered assessments widely used in neurology and examined the more relevant skills. In this article, each test we chose is described and particular attention is paid to the information they provided on impaired language abilities in schizophrenia. In this manner, we provide an accurate characterization of schizophrenia-associated language impairments and offer a solid foundation for rehabilitation. Current research makes connections between schizophrenia and other neurological disorders concerning language. Nevertheless, further studies are needed to explore these connections to complete our investigations. The strategies we designed are aimed at enabling a subject with schizophrenia to improve his/her language skills. We support the idea that such improvement could be reached by speech therapy. We conclude that speech therapists can play an important role in the non pharmacological treatment of schizophrenia, by selecting appropriate interventions that capitalize on spared abilities to compensate for impaired abilities.     

The linguistically aware teacher and the teacher-aware linguist

This review evaluates issues of teacher linguistic knowledge relating to their work with children with speech, language and communication difficulties (SLCD). Information is from Ellis and McCartney [(2011a). Applied linguistics and primary school teaching. Cambridge: Cambridge University Press], a state-of-the-art text deriving from a British Association of Applied Linguistics/Cambridge University Press expert seminar series that details: linguistic research underpinning primary school curricula and pedagogy; the form of linguistic knowledge useful for teachers supporting children with SLCD in partnership with speech and language therapists; and how and when teachers acquire and learn to apply such knowledge. Critical analysis of the options presented for teacher learning indicate that policy enjoinders now include linguistic application as an expected part of teachers' professional knowledge, for all children including those with SLCD, but there is a large unmet learning need. It is concluded that there is a role for clinical linguists to disseminate useable knowledge to teachers in an accessible format. Ways of achieving this are considered.     

Makaton peer tutoring evaluation: 10 years on

The present paper describes an audit of the work of 164 Makaton peer tutors working in 23 establishments in England, Scotland and Wales. Questionnaires were sent to managers, Makaton peer tutors and facilitators (i.e. day centre staff, speech and language therapists, and teachers). The purpose of this study was to examine the effect of the Makaton peer tutoring scheme on the communication skills of all those involved. In addition, information was obtained from all participants about how the scheme had affected them, and what they thought had contributed to its success or failure. Sixteen establishments reported that the scheme had not only contributed to an increase in communication and the effectiveness of interaction, but that it had also resulted in an increase in self‐esteem, confidence and assertiveness. Out of those establishments which had stopped using the Makaton peer tutoring scheme, the loss of the facilitator was the most common cause.     

Promoting lexical learning in the speech and language therapy of children with cochlear implants

This study examines lexical intervention sessions in speech and language therapy for children with cochlear implants (CIs). Particular focus is on the therapist’s professional practices in doing the therapy. The participants in this study are three congenitally deaf children with CIs together with their speech and language therapist. The video recorded therapy sessions of these children are studied using conversation analysis. The analysis reveals the ways in which the speech and language therapist formulates her speaking turns to support the children’s lexical learning in task interaction. The therapist’s multimodal practices, for example linguistic and acoustic highlighting, focus both on the lexical meaning and the phonological form of the words. Using these means, the therapist expands the child’s lexical networks, specifies and corrects the meaning of the target words, and models the correct phonological form of the words. The findings of this study are useful in providing information for clinicians and speech and language therapy students working with children who have CIs as well as for the children’s parents.     

Current status of stuttering therapy in preschool and school-age children in the Federal Republic of Germany: results of a questionnaire study among therapists and analysis of the literature

It is evident that no empirical research has been carried out within the preschool age-group of stuttering children and also that information on the subject published in international and especially in the Anglo-American literature has not received the attention of German therapists. Rather than concentrating upon the stuttering child's speech and language, they attempt to convey to the child a greater pleasure in speaking and in communicating; this may result in symptoms that could aggravate prognosis. More than half of the therapists maintain the same attitude toward school-age children. The review of the literature and the replies to the questionnaire show that German therapists require new orientation toward scientific investigation and new concepts in the treatment of stuttering preschool children.     

Challenging Behaviour Through Communication

Individuals who challenge services are of central concern to providers of care for people with learning disabilities. Speech and language therapists working in this area have been amongst those who recognise that ‘challenging behaviours’ may usefully be considered as a form of communication and that communication should be a central issue in a holistic approach to challenge. This paper describes a multi-disciplinary and communication-centred approach to meeting the needs of individuals labelled as challenging and living in ‘Dolby Lodge’, a small residential unit. The elements of this approach are considered and illustrated in relation to one individual and suggestions made as to the role of the speech and language therapist with this population.     

Processing melodic contour and speech intonation in congenital amusics with Mandarin Chinese

Congenital amusia is a disorder in the perception and production of musical pitch. It has been suggested that early exposure to a tonal language may compensate for the pitch disorder (Peretz, 2008). If so, it is reasonable to expect that there would be different characterizations of pitch perception in music and speech in congenital amusics who speak a tonal language, such as Mandarin. In this study, a group of 11 adults with amusia whose first language was Mandarin were tested with melodic contour and speech intonation discrimination and identification tasks. The participants with amusia were impaired in discriminating and identifying melodic contour. These abnormalities were also detected in identifying both speech and non-linguistic analogue derived patterns for the Mandarin intonation tasks. In addition, there was an overall trend for the participants with amusia to show deficits with respect to controls in the intonation discrimination tasks for both speech and non-linguistic analogues. These findings suggest that the amusics’ melodic pitch deficits may extend to the perception of speech, and could potentially result in some language deficits in those who speak a tonal language.     

The agreement of caregivers' initial identification of children's developmental problems with the professional assessment in Taiwan

Children's developmental problems vary, with some easier to identify than others. The accuracy of caregivers’ initial identification of children's developmental problems is important in the timely treatment of those problems by medical professionals. In this study, we investigated the degree to which caregivers’ initial identification of children's developmental problems matched the clinical assessment by a team of qualified professionals in a developmental assessment unit of a medical center in Taiwan. The practitioners included a pediatric neurologist, a psychiatrist, a psychologist, an occupational therapist, a physical therapist, and two speech therapists. Caregivers of 943 children (age range: 2-80 months; mean: 37.7 months) who visited the unit for a suspected developmental problem were interviewed about the chief problem that led to the caregivers bringing their children to the unit. The results showed high agreement in the global and the motor domains between the caregivers and the professionals, and low agreement in the cognitive and the speech/language domains. The agreement was significantly related to the caregivers’ native origin and socioeconomic status index (SSI). Caregivers with a foreign origin (immigrant mothers) and low SSI were more likely to misidentify their children's problems. It is recommended that pediatric practitioners offer continuing education to caregivers, especially in the domains of cognitive and speech/language development.     

Behavior problems in children with speech and language retardation

A systematic evaluation for speech and language retardation and behavioral disorders was conducted on 100 children (mean age five years, six months) presenting consecutively to a suburban speech and hearing clinic. It revealed that parents, teachers, and an examining psychiatrist agreed that these children frequently had associated behavioral problems, some quite common. This indicated the need for a speech or language therapist to systematically assess a child for possible behavioral problems in order to establish a more comprehensive and effective treatment plan for the child.     

When hearing clients work with a deaf therapist

Not being able to hear can present significant challenges for the therapist and for the deaf therapist/hearing client dyad. It can also create opportunities. Although the literature indicates that most culturally Deaf therapists work with Deaf clients due to their mutual use of American Sign Language, I describe (a) the background of an audiologically deaf therapist who relies on speech reading rather than sign language, and (b) this therapist's clinical work with hearing clients. Some of the relational dynamics of these treatments are identified, and I conclude by noting how attention to communication can benefit the work of all psychotherapists.     

The relationship between socio-economic status and lexical development

The British Picture Vocabulary Scale, second edition (BPVS-II), a measure of receptive vocabulary, is widely used by speech and language therapists and researchers into speech and language disorders, as an indicator of language delay, but it has frequently been suggested that receptive vocabulary may be more associated with socio-economic status. Studies on this topic have produced conflicting results. This study reviews the literature and tests the hypothesis that receptive vocabulary is associated with socio-economic status. The BPVS-II was administered to 76 typically-developing children aged 4 to 11, classified according to deprivation category, in Edinburgh, Scotland. The results showed no significant correlation between the two measures. Error patterns within the results are examined to discover why there should be discrepancy between them and the findings of other studies. The interaction between word frequency and the items used in the BPVS-II is examined, and implications for the use of the BPVS-II with all children of primary school age are discussed.     

Early speech- and language-impaired children: linguistic, literacy, and social outcomes

The aim of this study was to follow-up prospectively a cohort of preschool children originally recruited from successive referrals to speech and language therapy community clinics and to investigate their linguistic, literacy, and social outcomes at 7 to 10 years of age. Three hundred and fifty children aged 84 to 113 months (mean age 99.9mo [SD 5.4mo]) were singletons from monolingual backgrounds where there was concern about their speech and language development. Children who had severe learning difficulties, autism, oromotor deficits, dysfluency, or dysphonia were excluded. Altogether 196 (56%), 134 males and 62 females, were seen at follow-up. A control group of children who had never been referred for speech and language therapy, 57% of whom were males, was also recruited (n=94; mean age 104.4mo [SD 6.8mo]). All children were assessed on standardized measures of speech, language, and literacy. Teachers and parents completed questionnaires on educational and social outcomes. In total, 139 children in the cohort were within the normal range on standardized language assessments. About 30% of the original cohort of children continue to struggle with language, literacy, and social difficulties. The study demonstrates the long-term nature of language impairment and reinforces the need for awareness among professionals in child development and education of the ongoing needs of this population of children.     

The assessment of the sexual knowledge of a person with a severe learning disability and a severe communication disorder

This paper arose as a consequence of joint working between therapists of two different disciplines – clinical psychology and speech and language therapy – on a case involving a young woman who required an assessment of her sexual knowledge and attitudes. It explains how the recent development of a method of communication for those with a severe communication disorder (Talking Mats) has meant that it has become possible to work with those who have a severe learning disability and poor communication. In the past, clients with both severe learning disability with poor communication may have been excluded from traditional and cognitive therapy, which was dependent to a large extent on verbal communication. This paper, therefore, is of value in extending the range of methods for assessment and intervention that may be used by a range of disciplines with people showing severe learning disabilities and severe communication disorder.     

Reliability of the 36-item version of the Token Test in patients with poststroke aphasia

Abstract

Aim:

The purpose of this study was to investigate the intra- and inter-rater reliability of the 36-item version of the Token Test.

Methods:

Twenty-four people following stroke with mild disorder of language comprehension were assessed by two speech therapists at a distance of 2?days apart.

Results:

The test showed excellent and good inter-rater reliability, while some parts had lower coefficients.

Conclusion:

This version of the Token Test can be used to assess mild disorder of oral language comprehension. However, further clearer instructions for administration and scoring may improve the test reliability.     

Phonological and language disorders in children who stutter: impact on treatment recommendations

In the profession of speech‐language pathology, it is commonly reported that children who stutter, as a group, are more likely to have phonological and language disorders than their non‐stuttering peers. Some support for this belief comes from survey studies that have questioned speech‐language pathologists about the children on their caseloads who stutter. Recently, one such study reported that 44% of children who stuttered had at least one additional communication disorder (Arndt & Healey, 2001). In the present investigation, speech‐language pathologists (n=127) who were treating children with speech and language disorders were questioned about their views on the treatment of stuttering. The results indicated that children who stutter and have at least one additional disorder are more likely to be recommended for treatment than those whose only disorder is stuttering. This suggests that caseload surveys may overestimate the rate of additional communication disorders in children who stutter. The results provide reason to question the widespread belief that children who stutter have a high rate of concomitant disorders, especially when it is based on caseload surveys. Suggestions are offered for ways to determine more precisely the frequency with which stuttering co‐occurs with other speech and language disorders in children through large‐scale epidemiological research.