Speechmag

Pam Enderby recognised for lifetime aphasia contribution

I was delighted to hear today that Professor Pam Enderby has been given The Robin Tavistock Award 2012 in recognition of her significant lifetime contribution to the field of aphasia. 

In announcing the award, the Tavistock Trust for Aphasia recognise that listing the extent of Pam's contribution and influence would be 'impossible'. However, they make a valiant attempt, giving particular mention to publication of the Frenchay Aphasia Screening Test, Pam's championing of new technology and development of Therapy Outcome Measures, as well as her pioneering work in establishing the Speech and Language Therapy Research Unit at Frenchay Hospital in Bristol. 

Beyond the evidence of specific achievements which have had a direct and sustained impact on people with aphasia, the Trust also try to capture what it is about Pam that makes her "a catalyst, who makes things happen and succeed". They mention her mentoring, capacity to bring people together, energy, compassion, generosity and sense of fun. To this I would add honesty, realism and high expectations of people's capabilities. 

Congratulations Pam - and lang may yer lum reek. 

 

Communication Champion's final report shows communication is everyone's business

Despite her two year term as Communication Champion officially ending in December, Jean Gross was up with the lark this morning for a 5 minute slot on the Daybreak sofa to talk about ‘testing’ of 2 years olds. 

Having read her carefully considered and detailed final report, I knew that what Jean had actually asked for was inclusion of “a measure of children’s communication and language development at age two” (p.10) in the Department of Health’s Public Health outcomes framework. On the report's release a week ago, the press furore was around its supposed call that parents should receive texts to remind them to talk to their children. What Jean actually recommended was that the Department for Education should “provide parents with interesting, accessible information on how to enjoy and support their child’s communication and language development from birth onwards, using…the full range of technologies – phone apps with free film and text content, social media, texting, daytime television and so on – in order to ensure reach” (p.11). 

Early identification, workforce capacity building, skill mix and team work, joint commissioning, user and voluntary sector involvement and the need to measure impact are all among the report’s recommendations. There is a focus on specialist services including AAC, speech and language therapy provision in different settings, and hard to reach populations. A strong theme is the need for greater recognition of speech, language and communication difficulties in children with behaviour problems. There is plenty of food for thought for speech and language therapists when Jean highlights the continuation of ineffective models of intervention where therapists are expected “to ‘fix’ children through face-to-face work” (p.25) and urges us to question our practice in relation to people who do not attend.

In using examples from a number of places which have really embraced the idea that communication is everyone’s business, Jean shows that transformation is a realistic prospect even when budgets are under enormous pressure. This contrasts with her frustration at the loss of services in other areas and concerns about the long-term impact.

I have often reflected on the strength of character, strategic nous, inveterate networking and chameleon-like adaptability that a ‘champion’ position requires. Presenting complex arguments in soundbites to answer TV presenters' questions such as “Do you think children as young as 2 should be tested for how well they speak?” is just another prerequisite of the job. Admittedly “Do you think it is better to spot a communication problem early and help a child and their family rather than letting them struggle?”, “Do you think good quality information should be available to parents who want to know more about child language development?” and “Do you think people working with young children should know how to get them listening and talking well?” don’t invite quite the same controversy. 

On the positive side, every media opportunity raises awareness of communication and gets people talking about talking, and the Communication Champion’s role has been to make this happen at every level. Media coverage is aimed at the general public but, for those with a real interest in supporting children's communication, the report offers a more complete picture of where we are at and where we should aspire to be going. 

 

In Giving Voice we are proud to be speech and language therapists

I have watched with admiration as the Giving Voice campaign has spread the message across the UK that speech and language therapy transforms lives.  

Having been active in both Speak Weeks (circa 1987 and 1990) and the rather oddly named SpeakWatch (1994), it is fascinating to see how tools for raising awareness and ways of measuring success have changed, while the passion and many of the issues have not.

The Royal College of Speech & Language Therapists now has a Policy and Public Affairs Team which has provided the advice, coordination and resources to inspire and enable therapists at a local level to get active. One of the most useful of these is the report from Matrix Evidence into the cost benefits of speech and language therapy. (College members can calculate the savings for local services to people with dysphagia, aphasia, specific language impairment and autism here.)

Although the hard statistics following Tuesday's mass mobilisation event and awards ceremony are encouraging enough in themselves (255 turned out for the Giving Voice rally, over 100 MPs were met, and over 400 tweets including #givingvoiceuk were published), the softer ripple effects count even more in the longer term. This includes the increased camaraderie among teams and the success of shared projects and a common purpose with service users.

For Jennie Marshall - who cycled 180 miles to the event using a Lightwriter to communicate - it has provided a great deal of insight and opportunity for reflection. As she said at the Giving Voice rally, "The cycling is child's play compared to using a communication aid...I can't imagine how life would be if I didn't have a voice." A number of younger members of the profession including Sophie Jankel (Social Media Campaigner of the Year award) and Julie Carr (Outstanding Contribution award), have found their campaigning voice and I have no doubt we will all benefit from this in the years to come. 

As veteran campaigner Pam Enderby said, we want to do something about the fact that speech, language and communication difficulties affect relationships, education and employment, and we need to do it "in the context of an ever-moving NHS." Compared with times of previous campaigns we have more evidence, our therapy is more effective we will not be driven into losing our care. "It's not just a job, it's a part of our lives...I am very proud to be a speech and language therapist."

The photos show Ele Buckley, RCSLT National Coordinator for Local Campaigns, with the rally on Westminster Bridge, and Sophie Jankel receiving her award at Church House from Rt Hon John Bercow MP.  

 

Penultimate issue of Speech & Language Therapy in Practice now out

The Autumn 11 issue of Speech & Language Therapy in Practice has been mailed today, so subscribers can expect it through their door very soon!

Cover star Dan sustained a severe head injury in 2007, and Lindsay King describes how revisiting Melodic Intonation Therapy has helped his recovery. Our second 'How I manage acquired brain injury' contribution comes from Laura Flynn in Jersey and is written in memory of another inspiring client, Suzannah Pemberton.

The client-centred theme continues with Karen Leadbitter's reflection on empowering Rhys, a man in his thirties with Down's syndrome, to participate in training his own staff. Lynsey Paterson also concentrates on training, using a literature review to develop parent training following an autism diagnosis.

In the well received Journal Club, Jennifer Reid tackles critical appraisal of observational studies, and subscribers can download two associated frameworks from the members' area of www.speechmag.com. Sam Simpson & Cathy Sparkes continue their goal negotiation series, and include discussion of the thought-provoking Model of Change by Prochaska and DiClemente (1986).

In 2009, Louise Greenstock wrote an interim report on her PhD research into the use of graphic symbols in schools, and here she shares her final findings. These include a theoretical framework which looks as if it would be very helpful in practice.

Alison Roberts is back with 'Here's one I made earlier'. Her low cost and fun therapy suggestions for groups have proved so popular that Speechmark has released a book of them! Cynthia Pelman tells us about one of her top resources, Stern Structural Arithmetic, and Jan Broomfield explores the ethical issues raised when your new referral is the son of your Trust's Chief Executive Officer... 

As well as reviews and editor's choice from the journals, we have brief contributions from Diana James about Paget Gorman Signed Speech, and a delightful snapshot of Nicola Grove's granddaughters talking about talking. As always there are great reader offers, including a Grow Words resource set, books from Plural Publishing and the recently released New Reynell Developmental Language Scales (NRDLS).

You can sign up for all 4 issues in the final year of Speech & Language Therapy in Practice. You will also receive the Winter 10 issue free, and get access to the members' area of www.speechmag.com until 29 February 2012.

Voice banking to preserve the freedom of speech

More on voice banking, a subject I posted on a year ago when Laurence Brewer was interviewed for Radio 4’s Word of Mouth. This time there was a Scottish flavour to another Radio 4 programme ‘Giving the Critic Back His Voice’, presented by Deacon Blue’s Ricky Ross.

Mike Arnott - who is originally from Belfast but now lives in Aberdeen – is 45 and has motor neurone disease. He was referred to speech and language therapist Karen Yuill at a time when he had no speech difficulties to explore possibilities for voice banking. Like Laurence, his goal was primarily to ensure his children would still be able to hear him as him in the event of him losing his speech and voice as the disease progressed. As he says, “How you sound is so much of who you are.”

Karen explains that she had to go away and do a bit of reading and, “We kind of explored the whole thing together really”. Initially this was via ModelTalker, which was straightforward but left Mike a little disappointed.

The next port of call was Edinburgh based company CereProc. They specialise in characterful speech synthesis, and created a text-to-speech voice for film critic Roger Ebert from his recorded documentaries when he was diagnosed with thyroid cancer. The process adopted for Mike involves software recording thousands of phrases and sentences based on phonetic coverage so that all speech sounds can be captured in a way that will make the synthesis sound as natural as possible.

The programme explores the difficulty for synthetic voices in conveying emotions and feelings adequately, including humour, boldness, fear, anger, excitement and joy. Joanna Courtney from CALL Scotland is interviewed about CereProc’s female Scottish voice ‘Heather’, as is Louise Smith whose 19 year old daughter Leanna has Worster-Drought Syndrome. She has been excited to get the Heather voice for her communication aid as it sounds “so normal”.

Michael Arnott says that after the months of recording there was “a hesitation pressing the play button just in case I’d be disappointed – but I certainly wasn’t.” Most importantly, his 8 year old immediately said, “'That’s you daddy!' And I was so pleased because all of that’s been part of the goal...they still hear me as me.”

You can download Scottish voices from the CereProc website. The programme is available for a limited period on BBC iPlayer.

Picture menu launched to help people with communication difficulties in hospital

No-one would choose to be in hospital but, if we have to be, the majority of us can at least read the hospital menu and choose our preferred dishes. Unfortunately people who have difficulty communicating - including those who have aphasia, or English as an additional language, or who find reading hard - don't have that luxury. As a result, they miss out on making choices for themselves, and may also miss out on nutrition.

Recognising the problem, speech and language therapist Karen Rodger started to explore the possibility of making an aphasia-friendly hospital menu around 10 years ago. In 2006 she wrote the article 'Some hae meat' about her project for Speech & Language Therapy in Practice. Today I was delighted to catch up with Karen as the Nutrition Standards Service Improvement Programme rolled out the finished product to the main hospital in her NHS area.  

High quality photographs of food choices on the hospital menu are presented in a large, durable ring binder. Copies are available in certain wards and through speech and language therapy and dietetics. Karen has worked with colleagues from dietetics and catering as well as with patients and carers to develop the resource. She is now hoping that the publicity surrounding the launch will make nursing staff aware of the availability of this simple but effective tool, and of the difference it can make to the lives of a variety of patients.

Identifying and supporting 'Other ways of speaking' to ensure everyone can have a voice

Gesure, signing, symbols, boards and books, adapted computers and Voice Output Communication Aids -  in the words of the Hello campaign, 'Other Ways of Speaking' that ensure everyone can have a voice.

My final year project 23 years ago was on 'Using computers with people with aphasia'. Technology has moved on unimaginably since then, and people with communication difficulties are benefiting as AAC (Alternative & Augmentative Communication) becomes ever more adaptable, portable and affordable.

Speech and language therapists have a crucial role in ensuring the 'other ways' are appropriate to the individual's needs and functional in real life situations. The difference matters between aphasia and dysarthria, a physical disability and intellectual disability, or a language impairment that may or may not involve comprehension, as does the age, personality and interests of the client. The right choice of 'other ways of speaking' and support to establish their use in everyday communication is vital.

Manufacturers of voice output communication aids are taking their role seriously. Euan Robertson is Clinical Application Specialist at DynaVox Mayer-Johnson. He says, "I strongly believe a manufacturer's job is not over when a device is sold. Implementation is the difficult part, and AAC manufacturers have a responsibility to help this process. As such, DynaVox have created the Implementation Toolkit and run free workshops across the country. Although DynaVox InterAACt software is demonstrated, the strategies can be used with any form of high or low tech AAC system."

The recently launched MyChoicePad is making impressive use of its website and social media to spread the word about appropriate and functional use through short videos. Developed with the full support and collaboration of the Makaton charity, 'chief juggler' Zoe Peden says, "The angle we've taken is not just that of a low cost AAC device, but more about building the skills for communication using symbols and signs."  

The Makaton charity has also been involved in the production of the free 'Other Ways of Speaking' resource, along with 1Voice, ACE Centre, ACE Centre North, Scope and Signalong, as member organisations of Communication Matters. Anna Reeves from ACE Centre North says, "It is imperative that the needs of children and young people who have difficulties speaking are identified at an early age. Finding the right method of communication can have a dramatic impact on a child or young person's life - helping them to express themselves, participate in decisions, and improve their self esteem, which will ultimately impact on their contribution to society at large."

For proof of this, you only need to watch this video, produced by the ACE Centre for Hello, as part of the National Year of Communication:

 

Communicating with young people about mental health and wellbeing



This afternoon I went to a twilight seminar for a range of professionals. We heard about the findings of a critical review of the literature on children and young people’s views on the factors that influence their mental health. One of the authors, Jenny Spratt, summarised the findings of the review’s 137 pages and we were then encouraged to reflect on how they relate to and can inform practice with young people, whether at school or in the wider community. The four most important influences for young people emerging from the review are all familiar territory for speech and language therapists:
- Social relationships
- A need to feel normal and fit in
- Transitions
- Control over choices.

One of the attendees talked about the challenges of finding the right language to use with young people to discuss their mental health and wellbeing. Jenny has found simple concepts such as ‘good’ / ‘bad’ can be the most effective.

By coincidence, earlier on today I had an order for a 2010 article by Yvonne Macleman. It examines how speech and language therapists can work with Child & Adolescent Mental Health Services using Talking Mats to facilitate accurate mental state assessments in young people with speech, language and communication difficulties.

Talking Mats is a low technology communication framework involving sets of symbols designed to help people with communication difficulties think about issues and express their opinion. Yvonne’s article included an example of their use with Greg, a young man with Asperger’s syndrome. She says his mother “spontaneously commented on two separate occasions that she felt the Talking Mat was an easier way for her son to express his thoughts and feelings around a difficult area.” A family therapy colleague also commented that he “thought the Talking mat could actually be ‘emotionally containing’ for both the young person and their family” (p.9).

Jenny Spratt talked about the irony that  children who are generally happy find it difficult to express the positive factors impacting on their wellbeing while, in contrast, the review says that “some of the most insightful thinking about ‘normal’ states of mental health in young people comes from those who feel they have somehow been tipped beyond this” (p.62). In a similar way, we know that work done with people with speech, language and communication difficulties gives lots of clues about the kind of language and supported conversation that is equally useful with young people who do not have such specific needs.

References
Macleman, Y. (2010) 'Talking Matters', Speech & Language Therapy in Practice Spring, pp.8-10.
Shucksmith, J., Spratt, J., Philip, K. & McNaughton, R. (2009) A critical review of the literature on children and young people's views of the factors that influence their mental health. Edinburgh: NHS Scotland.

Acknowledgement
Thank you to Sue Briggs, Senior Community Learning & Development Worker in Laurencekirk for inviting me to the seminar.

Why it's worth attending major exhibitions like Naidex and Talk Shop

The needs of people with communication difficulties will be well represented at the Naidex exhibition, which starts tomorrow at the NEC in Birmingham.

It’s a shame I’ve never managed to get to this annual showcase for products to aid independent living, as I’ve found other exhibitions such as BETT, the Communication Matters roadshows and Talk Shop inspiring and informative. As Louise Scrivener of Talk Shop says, such events give you “the space and time to re-discover your passion for your work...discover new ideas and products...and most importantly to network and update your CPD.”

Naidex runs from 5-7 April 2011. Wordswell speech and language therapist Janet O’Keefe will be speaking on inclusive practice in special educational needs, and the Association of Speech & Language Therapists in Independent Practice (ASLTIP) will be exhibiting for the first time. The ‘Communication Village’ area features well-known names in alternative and augmentative communication.

If this is too short notice, TES Education North is from 8-9 April at Manchester Central. Or you can keep Friday 30 September in mind for the third Talk Shop. In a development from previous years, this will now be the National Speech & Language and Occupational Therapy Fair and will include Communication Champion Jean Gross as the keynote speaker.

'Hello' to the National Year of Communication

Tsars, supremos, working parties, interdepartmental committees, royal commissions - it's easy for 'Yes, Prime Minister' (Gielgud Theatre, London) to be cynical. While the playwrights have a point, I had just come from a Communication Trust reception at the House of Commons which had a much more positive feel. It reminded me of the good that politicians can do, and of the potential of the National Year of Communication initiative and the appointed Communication Champion to make a real difference.

The National Year of Communication, which will run throughout 2011, is called 'Hello'. It aims to make children's communication skills a priority in homes and schools across England. Working with the Communication Champion Jean Gross, the year will be "managed and delivered" by The Communication Trust. This group of 39 voluntary and community sector organisations has the interests of children with speech, language and communication needs at its heart.

Mike Kennard of Signalong told me it is "the most effective coalition I have ever been involved with" - and, seeing the impact its work is having at the highest level, I can believe it. That doesn't mean it has been easy. As the Director of the Communication Trust Anita Kerwin-Nye said, tongue only half in cheek, "Some of us don't even like each other!" Resolving that she "will not rest until specific language impairment and speech, language and communication needs are as well understood as dyslexia or autism", Anita added, "The only way we're going to fix this is collectively. Everybody needs to 'get' it."

The reception at the House of Commons was sponsored by Robert Buckland MP, whose particular interest in this area has come about through his experience as a parent. The 150 guests heard a number of speakers, including Amanda Ryalls, whose son uses a voice output communication aid, Chris Pike, a young aspiring politician who has been diagnosed with Asperger's Syndrome, and Minister of State for Children and Families Sarah Teather. 

A fuller report of the event and the key messages for speech and language therapists will be in the Winter 10 issue of Speech & Language Therapy in Practice.