Speechmag

Life and times of a speaking wifie

Catherine Hollingworth may have been a visionary and steely pioneer of the speech and language therapy profession, but in the small Scottish town where she was born she was known straightforwardly as 'the speaking wifie'.

As part of a drive to recognise and celebrate the achievements of 'weel kent Brechiners', Steve Nicoll of the Friends of Brechin Town House gave a fascinating talk on Catherine's life, work and family history last week. Born in 1904, Catherine came from a family with a culture of high achievement and entrepreneurship, with one of her ancestors credited for taking a stand against the practice of body snatching for medical education in the 1800s.

Catherine's independent income meant she was able to pursue her interest in drama through studying at RADA. She may have simply developed her drama teaching, but a road traffic accident in Kirriemuir in 1933 led her to use her learning to address the injury to her own speech. This ignited an interest in speech therapy at a time when speech therapists were self-taught and very thin on the ground.

In 1940, while another pioneer of the profession Lionel Logue was supporting King George VI in London, Catherine was appointed as the first Superintendent of Speech and Drama and Speech Therapy in Aberdeen. According to Steve Nicoll, who has spoken to a number of Catherine's students, her attitude to teaching was disciplined, structured, hard but fair - and she was always right. However, the core values she sought to develop through drama teaching would not be out of place with educational thinking of today: confidence, communication, citizenship, civility, language, personal discipline and personal development. Significantly, Catherine was a great believer in the importance of peer learning, and kept the number of adults involved to a minimum.

In her later years, Catherine came out of retirement to do voluntary work in Dundee with people who had had a stroke. Although some of the specific methods were clearly of their time, it is telling that Catherine recognised the void when people with aphasia were 'left' at the end of speech therapy with no help, and she sought in a variety of ways to help re-build their confidence, self-esteem and social contact.

The profession has come a long way, but being aware of where we have come from can be as inspiring for the 'speaking wifies' of today as recognising where we are now and where we are going.

 

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. 

 

The communication and interaction skills of speech and language therapists applied more widely to healthcare

As speech and language therapists we are highly attuned to interaction. We recognise the link between communication competence and how people feel about themselves. Many of our interventions encourage ‘significant others’ to make changes to their communication. This gives our client (the spouse with aphasia, the child with language delay, the parent with dementia or the young person with a stammer) the chance to express themselves more effectively and be a more equal partner in the exchange.

Much of healthcare is relational and ‘poor communication’ is recognised as an ongoing problem. The experience of speech and language therapists and their clients therefore has wider relevance for interactions between healthcare staff and users of services.

Video Interaction Guidance, Non-Directive Therapy and Solution Focused Brief Therapy approaches have found favour in speech and language therapy and across the helping professions, while Talking Mats and Parent-Child Interaction Therapy originated in speech and language therapy and have been widely applied. Now Ray Wilkinson, a speech and language therapy researcher behind the hugely influential SPPARC (Supporting Partners of People with Aphasia in Relationships and Conversation), is looking to extend his conversation analysis expertise to the broader training of healthcare workers.

Ray was invited to present last week at a multidisciplinary symposium on ‘Communication and Interaction: Applications for Healthcare’. The common bond between most of those attending was an interest in using conversation analysis as a research tool. The diverse backgrounds – such as sports, sociolinguistics, management and health – made for lively and thought-provoking discussion. For some, Ray’s before-and-after video examples were the first time they had really thought about what it might be like to live with – and to live with someone with – a communication impairment such as aphasia or dysarthria. It was also an opportunity for them to see how transformative speech and language therapy intervention can be. 

Ray is clear that we don’t get a true picture of everyday talk from what we see in a clinic. Analysis of more natural interaction shows that, in their effort to adapt to and cope with a communication disability, families can get stuck in a particular interaction style such as a pedagogic (teacher/pupil) pattern. Importantly, he stressed that intervention is not so much a result of judging how ‘good’ or ‘bad’ the interaction is, as raising awareness that there are other options. These may produce different benefits such as greater participation in spite of a persisting impairment.

Although Ray says there has been a lot of work done on improving the communication skills of healthcare workers, this tends to concentrate only on the professional. In contrast, his Interaction-Focused Analysis and Intervention recognises that communication depends on at least two people. What matters is what happens in the space between them, and how they experience it. As much of the way we communicate is below our level of consciousness, video and natural settings provide an effective and generally acceptable way of raising awareness of interaction and the potential impact of adjusting it. 

Later during the symposium we split into groups to discuss a transcript of an interaction between a community nurse and a client. This was a stark reminder for me that, however 'good' or 'bad' anyone judges the particular interaction to be, we should be mindful of the context in which the communication is occurring. Health professionals and the system they are constrained by hold a great deal of power. As with communication much of this is below the level of consciousness but, in raising awareness, we should find there are other options. 

Speech & Language Therapy in Practice editor Avril Nicoll attended the University of Stirling sponsored 'Communication and Interaction: Applications for Healthcare' event on 27 January 2012 as a student on the MRes (Health). 

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.  

 

Aphasia charity needs online votes to Speakeasy

It is sad that, in spite of top level commitment to user involvement and community engagement, funding cuts mean charities including Speakeasy are having to seek income through routes such as the NatWest CommunityForce, where entrants are in competition for public online votes to win £6000.

Speakeasy was established in Bury almost 30 years ago with support from both social services and the NHS. Over the years the social services support was gradually withdrawn, but the primary care trust financed core services to which Speakeasy added a range of project work such as developing employment opportunities, computer therapy and piloting new approaches for people with aphasia.

Gill Pearl, Chief Executive of Speakeasy, wrote an article for the Winter 10 issue of Speech & Language Therapy in Practice with Gill Jackson of Dyscover, a specialist aphasia charity in Surrey. They described a pilot study of the Personal Development Programme, which promotes volunteering and increased activity among people with aphasia, bringing wide-ranging benefits to the participating individuals and their communities.

Gill explains, "Speakeasy has developed a justifiable reputation as a centre of excellence where people with aphasia from across the North West grow the skills to better navigate their lives with aphasia. In summer 2011, Speakeasy received the devastating news that the PCT had decided to withdraw 100 per cent of its financial support. This loss of funding may close Speakeasy. Although every effort is being made to seek alternative funds, the current financial climate and changes in the health and social care sectors are compounding the difficulties."

I have registered and cast a vote to support Speakeasy's attempts to win £6000 of stop-gap funding and hope other people who have an interest in aphasia will do so too before the closing date of 23 October. This doesn't have to mean that I like the recent trend among big companies to use social media to advertise their products. Such methods certainly will not provide a sustainable approach to funding of charities who provide important services that complement and enhance those offered by health and social care.

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.

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:

 

Summer 11 Speech & Language Therapy in Practice out now!

The Summer 11 issue  of Speech & Language Therapy in Practice magazine was mailed to subscribers on Friday and Saturday, so should be with you very soon.

As well as the second instalment in the new goal negotiation series and an 'In Brief' contribution that puts the accent on aphasia, we have an uplifting story of the evolution and impact of a total communication project across Devon. In 'Journal Club', Jen Reid provides a framework for critical appraisal of intervention studies, while 'Boundary Issues' looks at the ethics of new professional roles.

We hear about a collaborative project with a children's centre and library service in an area of deprivation, which seems to highlight the benefits of targeting training on selected individuals. We also get a glimpse into the speech, language and communication needs of prisoners completing community sentences.

The cover feature is on using the evidence in dysphagia management. Hannah Crawford and Julie Bake explain why they have moved away from previous practice and introduced oral taster programmes with people with learning disabilities who gain their nutrition via PEG, while Celia Harding and colleagues use a problem solving framework to support appropriate intervention for infants and children with early feeding, eating and drinking difficulties.

We have reader offers for Photosymbols 4, I CAN Secondary Talk narrative and a Grow Words resource set, as well as Editor's Choice, three pages of reviews and 'Here's one I made earlier' on encouraging clients to make their own books. As always it is good to the very last page, where Kate Balzer shares some of the ideas for working with people with dementia from a SIGDOM therapy swapshop.

Enjoy!

Music, Melodic Intonation Therapy and Giving Voice

"We found music provided an opportunity for people to express themselves and interact in a poignant way...This has given us food for thought about the link between communication, music and movement."

So say the speech and language therapy team for people with learning disabilities at Yourhealthcare, while reflecting on their Signsational training in the Spring 11 issue of Speech & Language Therapy in Practice (pp.28-29).

Another speech and language therapist, Lindsay King, has been pondering the link between singing and speech. Having heard about the resurgence of interest in Melodic Intonation Therapy (which I reported in 2007), she introduced it to a young man with a brain injury with promising results.

Lindsay wrote this up as a case study which will feature in the Autumn 11 issue of Speech & Language Therapy in Practice. Her Trust then asked her to write a summary of the approach in its new Cumbria Partnership Journal of Research, Practice and Learning (freely available online and well worth a read). With interest in speech and language therapy fuelled by The King's Speech, journalists picked up on her contribution at the Journal's launch, and her client was delighted to be interviewed and photographed for his local paper.

This is a really good example of the same 'story' being presented in different ways to suit the needs of different recipients. It also shows the advantages of therapists and clients working together to tell the story, as is being encouraged by the Giving Voice campaign. So go on, express yourself!