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This report describes the results of language therapy initiated 1 to 6 years after the onset of aphasia in 14 patients. During the course of treatment, each of the 14 patients improved strongly in their communicative abilities (PICA), according to clinical observation and reports from family, hospital ward personnel, or both.
The potential value of a framework enabling practitioners to conceptualise speech and language therapy from a range of perspectives engendered by different theories about disability is explored. Four disability research paradigms are used to categorise professional activities, whilst the 'individual' and 'social' models of disability are considered as alternative value systems. Challenges facing speech and language therapists in developing roles and services to embrace different perspectives are outlined.
The aim of this article is to discuss some of the important issues that form the basis of curriculum development for education in speech-language therapy and audiology. The demands of the profession are such that a horizontal occupational structure is no longer adequate in the multicultural, multilingual RSA context. It is therefore necessary to investigate alternative educational options to accommodate current needs. These may include diploma training for technicians, certificate programmes for community rehabilitation workers and professionally directed masters courses. It is also apparent that the professional functions of the speech-language therapist and audiologist have extended to the point where aspects such as computer literacy, management functions, community work and consultation should play a greater role in the curriculum than is the case at present.
The epidemiology of 1090 referrals to a mainstream paediatric speech and language therapy department over fifteen months is discussed, in relation to referral information and initial detailed assessment. Clients are classified by their main presenting difficulty and by their degree of severity. This information will inform clinicians of the nature of the caseload of a typical inner city service which will, in turn, aid service planning.
Health and Local Education Authority (LEA) personnel met in 1993 to consider how to meet the expanding caseload of children, needing speech and language therapy support in mainstream schools. The drive towards an inclusive policy for all children with special needs led to the joint funding of a peripatetic team of speech and language therapists (SLTs) and assistants. The preparatory training programmes for the team and school based staff focused on ensuring that differing perceptions, expectations and skills were acknowledged. Evaluation of the model has examined throughput, the opinion of consumers, pre- and post-therapy profiles of individual children and the team's view of their effectiveness in each school. The rotational service was implemented in 20 schools in January 1996 and 50 schools now participate.
OBJECTIVE: To evaluate the clinical and cost effectiveness of two training strategies to promote the use of research evidence in speech and language therapy (SLT) management of poststroke dysphagia. DESIGN: Pragmatic, cluster randomized trial. SETTING: Seventeen SLT departments in north-west England. PARTICIPANTS: Two SLTs from each department received training and cascaded information across their department. Process of care was measured from the notes of 708 patients with acute poststroke dysphagia across eight departments allocated to training strategy A, and 762 patients across nine departments in strategy B. INTERVENTIONS: Strategy A: training on the critical appraisal of published research papers and practice guidelines. Strategy B: strategy A plus training on management of change in clinical practice. MAIN OUTCOME MEASURES: Pre- and post-training adherence to practice guidelines in poststroke dysphagia management, based on a review of case notes. Incremental cost of increased adherence to clinical guidelines. RESULTS: Departments' practice differed in adherence to guidelines. Departments changed following training (F=2.22, df 16, 1436, p=0.004). The effect of training strategy on clinical practice was not significant. Strategy B departments engaged in more activities relating to research use following training than strategy A. Total costs of training averaged ł2001, 2892 Euros, $3886 (SD ł502, 726 Euros, $975) for strategy A and ł3366, 4866 Euros, $6537 (SD ł2121, 3066 Euros, $4119) for strategy B. CONCLUSIONS: Training in research implementation in addition to critical appraisal and guideline introduction is associated with increased dissemination activities and awareness of research information, but not with changes in clinical practice within six months of training. The department in which SLTs work influences their use of research. The process of poststroke dysphagia management can be measured using a tool developed from practice guidelines.
One of us has hypothesised that the 'voices' of schizophrenic patients reflect altered preconscious planning of discourse that can produce involuntary 'inner speech' as well as incoherent overt speech. Some schizophrenic patients reporting voices do not, however, have disorganised speech. We hypothesise that these 'counterexample' patients compensate for impairments of discourse planning by reducing language complexity and relying on highly rehearsed topics. A 'language therapy' designed to challenge and enhance novel discourse planning was administered to four such patients; three had significant albeit temporary reductions in the severity of their voices. These clinical findings provide further evidence that alterations of discourse planning may underlie hallucinated voices.
Mainstreaming is the process of transferring policy, activity or good practice from a community-based initiative, such as Sure Start, into the core service. This paper will explain how one Sure Start programme developed a strategy for speech and language therapy (S<) that had an impact on the development of mainstream S< provision. The strategy explained here has shown the potential for team working and multi-agency delivery of new services. The new service was based on quality standard setting (as highlighted in government policy); positive multi-agency working based on sharing and skill development; and consumer involvement in a quality evaluation cycle. This paper discusses the different factors in developing and mainstreaming a Sure Start initiative. These critical processes have been applied to one local Sure Start programme as an example of these elements in action.
BACKGROUND: Informal evidence suggests that many Speech and Language Therapy (SLT) students from outside of the UK and/or Republic of Ireland who come to the UK either do not return to their home country on qualification or do not practise as SLTs in the public sector. Many factors may contribute to this situation. Concern that it may result in part from a poor match between UK SLT education and the demands of the role in other countries led the Royal College of Speech and Language Therapists (RCSLT) to fund a study of international SLT students' experiences of UK qualifying courses. AIMS: To discover and describe the experiences, views and expectations of current and past international students studying SLT in the UK and past international students' experiences, views and expectations of practising as SLTS, both inside and outside the UK. To consider the implications of the findings for (1) international students planning to work as SLTs; (2) UK SLT students planning to practise outside the UK; and (3) all those involved in SLT education: educational institutions; supervising SLTs; RCSLT. METHODS & PROCEDURES: The study involved distributing 166 postal questionnaires (some directly to (ex)students and some to their Higher Education Institutes, or HEIs) and carrying out 23 interviews, with both current students and those qualifying since May 1994. Quantitative analysis was carried out using SPSS using descriptive statistics. Qualitative analysis used content and thematic analyses. OUTCOMES & RESULTS: Seventy-one questionnaires were received from current and past students, representing a minimum response rate of 43%. (It was not possible to verify exactly how many questionnaires were distributed by HEIs.) The results describe the diverse range of respondents' experiences of studying and working in the UK, their views of working in their home countries and the UK, and their suggestions about strategies that might be adopted to support them further. The results revealed that students come from a wide diversity of countries, with resulting differences in their experiences. However, there were some commonalities in the perceived advantages and disadvantages of working at home and in the UK. CONCLUSIONS: The suggestions for change included practical ideas for change both before and after qualification as an SLT. These included courses about the organization of health, education and social services in the UK, adaptations of course delivery and course work to include cross-cultural/linguistic work and 'home-based' projects. Implications of the findings and strategies for home as well as international SLT students are discussed.
Reports on a survey of 1990 and 1991 graduates entering the speech and language therapy profession in the UK and on the experiences of six new therapists in one "good practice" area, Ayrshire and Arran Health Board. Results show that new therapists were given a great deal of help and support from professional managers, and valued it highly. They chose posts which offered a mixed client load and good induction packages. Pre-service training reflected work carried out in service, but all client groups had not been accessed during training. Issues relating to throughput and case-load management required most support. They made successful personal adaptations to the work environment, and managers found them effective overall. Calculates the costs of supporting new therapists. Highlights the need to maintain professional support and discusses the potential difficulties involved in doing so in relation to NHS reforms.
In the past decade, there has been growing recognition of the need to involve clients in decisions about the healthcare they receive and in the evaluation of services offered. In health services research, survey and scaling methods have become important tools for research into 'consumer views' and the perspectives of people receiving healthcare. In spite of the increase in recent years in the participation of parents in their children's Speech and Language Therapy (SLT), there has been little attempt to investigate parents' perceptions and opinions of the services they receive. Moreover, there has been no previous attempt to derive a scale to measure these attitudes. The paper reports a study that explored the attitudes to therapy of 81 parents whose preschool children were receiving SLT intervention. Factor analysis of 12 items on a questionnaire revealed three issues salient in parental attitudes to therapy: practical help, emotional support and the perceived effectiveness of the service. The validity of these factors was supported by other findings from the questionnaire. The properties of the resulting scales are discussed and the ways in which they might be further refined and developed for use in SLT are suggested.
Changes in linguistic competence were assessed with the Aachen Aphasia Test in 18 aphasic patients across 8 weeks of spontaneous recovery, 8 weeks of intensive language therapy, and after a follow-up period of 8 weeks without therapy. CT scans were obtained from all patients and were evaluated for size of lesion and for affection of Wernicke's area, adjacent regions of superior and middle temporal gyrus, inferior parietal lesions, and temporobasal lesions. Size of lesion had a negative influence on recovery in all phases. Patients with lesions to temporobasal regions showed less improvement during therapy and less total recovery, but a similar amount of spontaneous recovery than patients without such lesions. Lesions that affected the temporobasal regions were on average larger than those which spared them, but the dissociation between reduced therapy success and unaffected spontaneous recovery became even more conspicuous when the concurrent effect of lesion size was minimized by appropriate selection of patients. Possibly, temporobasal lesions cause a disconnection between the hippocampal formation and perisylvian language areas and hinder explicit learning of linguistic knowledge and compensatory strategies.
This paper presents a paradigm that will help speech and language therapists learn how to improve their therapy and achieve the scientific goals of intervention more effectively and efficiently. The paradigm arises from the presenters' extensive clinical experience and represents a convergence of relatively diverse models of teaching and learning. Speech and language therapy which incorporates the critical characteristics from this paradigm is more stimulating and challenging for both the client and speech and language therapist.
INTRODUCTION: Language is almost always affected in fragile X syndrome (FXS) and a delay in language acquisition is one of the first characteristics. They articulate poorly and have a repetitive language, using the last word or sentence they have said or have been told. They have a tendency to change subjects as they talk and to repeat what they have heard. Even if comprehension is correct, they are unable to answer questions. Sometimes this is due to the fact that they don't expect the question or because they are not paying attention. They react better to short and concise commands. Their speech is fast with a poor control of the rhythm and inappropriate pausing in words, making it difficult to understand them. Some children with severe language dysfunction will require a complementary communication system to aid them. DEVELOPMENT: In speech therapy we will improve their communicative skills, both in comprehension as in expression, minimising or eliminating negative patterns, with exercises, techniques and strategies. Work is needed on the use of alternative language if necessary and finally work on feeding problems caused by the low muscular tone and on sensorial problems such as tactile hyper/hypo stimulation or difficulties to plan their movements. In conclusion, we must bear in mind that each child is different and so are their specific needs. CONCLUSION: We must know the individualities to provide for opportunities of development or of their control, and focus our objectives in a more real and effective manner.
This paper reports the pilot of a new technique for the development of students' clinical skills. A bank of simulated clients was used in the teaching of generic clinical skills to two groups of speech and language therapy students. The method for the training of actors and running of sessions is described in detail by use of both group and individual formats. The intervention was used with three groups of students at different points in a 2-year Masters degree course. Questionnaires to students evaluate the technique and the timing of its use in the course. It is concluded that this new type of clinical teaching is a valid and much-needed supplement to traditional individual National Health Service (NHS) placements.
BACKGROUND: The advent of evidence-based healthcare has seen a rise in the use of systematic reviews to bring together the findings from research studies. The use of systematic reviews in speech and language therapy (SLT) was criticized in this journal in 2004 by T. R. Pring. It was claimed that their findings are misleading due to the potential inclusion of biased data, and uninformative due to a lack of detail in the reporting of interventions. It is argued that outcome research should be carried out in a series of phases in which small-scale research precedes large-scale research. This, it is argued, is most likely to demonstrate statistically significant effects and also help to ensure that therapies become sufficiently defined so that clinicians can apply them in practice. AIMS: This paper argues that the above criticism of systematic reviews is based on a narrow conception of their capabilities: on the popular misapprehension that all systematic reviews answer effectiveness questions using only experimental studies and contain meta-analyses. Different methods for systematic reviews are described and their application within clinical outcome research is discussed with reference to a phased structure for empirical enquiry. MAIN CONTRIBUTION: Systematic reviews seek to identify and synthesize information within a given topic area. They are used to answer a wide range of research questions and the studies they include are not limited exclusively to experimental designs. Methods of synthesis can include both statistical approaches, such as meta-analysis, and 'qualitative' approaches, such as meta-ethnography and thematic analysis. Knowledge of the current state of research is essential for a sequentially phased approach within outcome research to operate. Since systematic reviews are summaries of research activity, they can provide this knowledge and should therefore be considered a valuable tool within outcome research. CONCLUSIONS: A systematic review using 'qualitative' and/or statistical methods for combining studies can be carried out within or across any of the phases within outcome research. Far from being uninformative, this can help bring together what is, and what is not, known and indicate the kinds of therapies that may be beneficial in the clinical setting and therapies which would benefit from further research and development.
With the development of separate community and the hospital trusts in the London borough of Hackney, at a time of increasing numbers and range of referrals, a number of gaps in service became apparent. The need for community adult speech and language therapy (SLT) in Hackney was identified, based on previous studies and other relevant literature. Comparison with services locally and nationally shows clearly that Hackney, in having virtually no community SLT for adults, is significantly disadvantaged. It was intended that this work would result in the widest consultation and discussion by the relevant agencies to explore ways of meeting this need.
Drooling and difficulty swallowing saliva are commonly reported in people with Parkinson's disease (PD). Drooling in PD is the result of swallowing difficulties rather than excessive saliva production. Currently, there is little research into the effectiveness of treatments to reduce drooling. The aims of the study were to develop objective measures of saliva volume and drooling for PD and to assess the efficacy of two therapeutic strategies to control drooling, i.e. specific speech and language therapy (SLT) including a portable metronome brooch to cue swallowing and injections of botulinum toxin into both parotid glands to reduce the amount of saliva produced. This paper will describe the assessments used, including the measurement of saliva, swallowing and drooling. The main focus will be the strategies used in the SLT intervention. The preliminary results are presented.