Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
approaches
A no failure method
This is IT!
The potential
of computers
Care
pathways
Should we follow?
Attention
control
Your firm and
flexible friend
A S E N S E O F D I R E C T I O N
ISSN 1368-2105
SUNNER oo
http://www.speechmag.com
Management
Clueing up for inclusion
How I manage
stammering
in adults
In my
experience
Right for the job
My top
resources
Early years
collaboration
vn
lna-Dent Gum
Nassagers
The Sprng o reader oer wnners are:
Miss C. Ward, Exeter and Anne Gosling, Colchester
(Talking Mats and Learning Disability)
Caroline Durso, Winchester (AlphaSmart 3000
- see review on p17)
Ciara Robertson, Aberdeen and Margaret
Purcell, S. Glos. (Speaking & Listening Through
Narrative from Black Sheep Press)
ongratuatons to you a!
Do you need to promote oral
activity or improve the action of
swallowing in children? Help is at
hand for five lucky readers! The Infa-Dent
Gum Massager is being used increasingly by
speech and language therapists for cases of
tongue palsy and paediatric dysphagia, and
Speech & Language Therapy in Practice has
parcels containing 12 packs to give away
FREE courtesy of Anglian Pharma. For your
chance to win, all you need to do is write a
postcard including your name and address to:
Infa-Dent Special Offer Draw, Dept SLTP,
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closing date for receipt of offers is 26th July
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A patented product originally designed as a
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Parcels of 12 Infa-Dent Gum Massager/Baby
Soft Toothbrushes retail at 25.80 and are
available from Anglian Pharma, tel. 01438
743070, the UK and Ireland distributor.
Summer 02 speechmag
Whether youre in need of
inspiration, doing a literature
review, or simply wanting to
locate an article you read
recently, our new cumulative
index facility is there to help.
The speechmag website now
holds:
Contents pages of the last four
issues
Cumulative index for previous
articles by author name and
subject - including abstracts
The editor has selected the previous articles you
might particularly want to look at if you liked the
articles in this issue. If you dont have previous
issues of the magazine, check out the abstracts on
the speechmag website and take advantage of our
new article ordering service.
If you liked...
Nibbhaya, try (103) Junor, B. (Spring 2000) In his
own style.
Myra Kersner & Ann Coxon, see (117) Gill, S. &
Ridley, J. (Summer 2000) Reshaping opportunities,
sharing good practice.
Tracy Robertson & Wendy McKenna, look at
(028) Adams, A. (Spring 1998) How I manage my
caseload. Community paediatric: a magic formula?
Julia Wade & Sarah Woodward, see (050)
Armstrong, L. & MacDonald, A. (Winter 1998)
Augmentation or extra effort? Using computers
with people who have aphasia, and (110) Lombard,
M. & Atkinson, Z. (Spring 2000) Assessments
assessed [Clicker 4].
Patricia Sims, try (118) Sims, P. (Summer 2000) A
change in direction.
How I manage stammering in adults, look at
(116) Sage, R.J. (Summer 2000) Reaching the parts
others dont.
Also on the site - news about future issues,
reprinted articles from previous issues, links
to other sites of practical value and
information about writing for the
magazine. Pay us a visit soon.
Remember - you can also
subscribe or renew online
via a secure server!
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Inside cover
Spring 02 speechmag
Reader offer
Win Infa-Dent Gum Massagers
8 Removing the obstacles
Many a time a parent has approached me saying,
My child needs help with his speech. His teacher says
its holding him back with his reading.
I usually offer to tackle the problem
the other way round.
In a profession undecided about its role
and boundaries, Patricia Sims uses
her no failure method to argue we
should be saying YES to literacy therapy.
12 Further reading
Literacy, non-verbal, palliative care,
voice, language, deafness.
13 This is IT
We hope that
our explanation of
our evaluation
protocol will
enable readers to
apply evaluation
procedures
independently,
thus keeping
abreast of
innovation. In
reviewing non-specialist software, we want to
encourage readers to think broadly when it comes to
software resources.
Julia Wade and Sarah Woodward check out
software packages and, with the help of J (a 73 year
old lady with aphasia), show that its never too late
to learn.
16 Reviews
Voice, learning disabilities, AAC, inclusion, aphasia,
paediatrics, dysphagia.
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 1
18 On the right track?
Within our department, clinics are often managed by
newly qualified therapists. They may benefit from care
pathways being in existence to provide guidance in
following an accepted departmental procedure which
should lead to increased
confidence in decision making.
Do care pathways help departments
provide a more consistent service
for preschool children? Tracy
Robertson and Wendy McKenna
turn to the literature to find out.
20 In my experience
Those embarking on a training
course should be doing so with as
clear and realistic an idea as possible
about speech and language therapy,
and should be sure that it is the
right decision to suit their skills, interests and personality.
Through organising speech and language therapy as a
career courses, Lucy Wood was reminded of the
positive aspects of the profession.
22Clueing up for inclusion
We hope that there may be a
commitment for increased funding to
support recruitment as well as
reorganisation of therapists working in
an inclusive educational system so that
services may continue to develop.
Myra Kersner and Ann Coxon ask how
speech and language therapy services are
meeting the challenge of inclusive education.
25 How I manage
stammering in adults
My aim in all therapy is to empower
the client to manage their stammer
long-term, by helping them to acquire
the understanding, therapy tools and
confidence needed to react to their
changing needs and circumstances.
Stammering is a multifactorial and com-
plex phenomenon with no known cure.
Our three contributors - Louise
Wright, Claire McNeil and Anne Blight - appreciate
that a holistic and individualised approach is required.
Back cover My Top Resources
Our team has recently started a quarterly newsletter,
Lets Talk, to inform the public and a wide range of
professionals (including health visitors, school staff and
paediatricians) about our service and topical projects.
Tracey Marsh and Clair Brookes make time for
collaborative working to meet the needs of their
community paediatric caseload.
SUMMER 2002
(publication date 27th May)
ISSN 1368-2105
Published by:
Avril Nicoll
33 Kinnear Square
Laurencekirk
AB30 1UL
Tel/fax 01561 377415
e-mail: avrilnicoll@speechmag.com
Production:
Fiona Reid
Fiona Reid Design
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St. Cyrus
Montrose
Website design and maintenance:
Nick Bowles
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Printing:
Manor Creative
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BN23 6PT
Editor:
Avril Nicoll RegMRCSLT
Subscriptions and advertising:
Tel / fax 01561 377415
Avril Nicoll 2002
Contents of Speech & Language
Therapy in Practice reflect the views
of the individual authors and not
necessarily the views of the publisher.
Publication of advertisements is not
an endorsement of the advertiser
or product or service offered.
Any contributions may also appear
on the magazines internet site.
Cover picture by Paul Reid. See p4.
Thanks to Karma Jiga and Rokpa Dundee,
tel. 01 382 872020.
(Rokpa Dundee, 51 Reform St. Dundee,
DD1 1SL specialises in Healthy Living
through Meditation, Tai Chi, Yoga,
Complimentary Treatments, Therapies,
Counselling & Tibetan Medicine. Please
contact us for more information.)
IN FUTURE ISSUES
COMPUTERS VOICE ADULT LEARNING DISABILITY EDUCATION
DYSPHAGIA CASELOAD MANAGEMENT APHASIA
Attention - your firm and flexible friend
Having observed qualities of attention control other than those
described in the literature, I decided to develop a descriptive model to
cover them, as more specific descriptions should lead to more
awareness about attention control and more specific treatment
strategies.
Nibbhayas work in progress on attention control is inspired primarily
by his work with children with autism and his experience of meditation.
The model can, however, be applied to any client group - and to ourselves.
4 COVER STORY
CONTENTS SUMMER 2002
Patricia Sims
J
www.speechmag.com
news
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 2
Common standards in
Conductive Education
Proponents of Conductive Education are welcoming funding for
a project to establish common standards in training across
Europe.
The project is funded by the European Union under its Comenius
programme which encourages transnational projects for school-
ing of children and improving the skills of educational staff.
Conductive Education is taught by specially trained Conductors
who work with individuals with motor disorders. Underlying the
teaching is the philosophy that all children and adults, no matter
how brain-damaged, can learn.
Andrew Sutton, director of the Foundation for Conductive
Education, commented, Our Foundation has a broad-church
approach to sharing the benefits of Conductive Education, fun-
damental to which is the creation of a conductor profession with
initial training to degree level. We are also keen to explore the
potential of training in Conductive Education for existing thera-
pists and teachers and are delighted that the EU is funding a pro-
ject to create common EU standards for such training.
Pot of gold for I CAN
The national educational charity for children with speech and
language difficulties is hoping for a pot of gold at the end of the
Rainbow of Hope.
I CAN, an officially nominated charity on the occasion of the
Queens Golden Jubilee, is being supported by Marks & Spencer
fundraising efforts. Children are being invited to place their
hopes and dreams for the next 50 years onto a Rainbow of
Hope at their nearest store. For each of the first 50,000 wishes
received, Marks & Spencer will donate 1 to I CAN. The retailer
will also welcome donations from customers and encourage
school children to take part in a Rainbow day where they wear
the colours of the rainbow at school.
www.ican.org.uk.
L-R, Helen Gowland of Tayside Speakeasy (and cover star
of the Winter 01 issue of Speech & Language Therapy in
Practice), John McAllion MSP, Convenor of the Public
Petitions Committee in the Scottish Parliament, and Alex
Frederick, Chairperson of Forth Valley Speakability.
The Scottish Parliament has heard loud and clear
the message that people with aphasia are a vul-
nerable group who need additional care and sup-
port to remain included in society.
Speakabilitys Forth Valley and Tayside groups
launched a petition on behalf of Scotlands 30,000
people with aphasia at the end of February at an
event attended by ten MSPs and fifty guests from
healthcare and the voluntary sector. The petitioners
received support from First Minister, Jack McConnell,
who said, I would like to assure you that a life dis-
abling condition such as aphasia will be given better
recognition, better support and better understand-
ing in order that the people who suffer from such
conditions can lead as full a life as possible.
Presenting the petition to the Public Petitions
Committee on 26 March, Alex Frederick and Claire
McArthur of Forth Valley Speakability were praised
by Convenor John McAllion MSP for the quality of
their opening statement. Committee members had
the opportunity to question the deputation which
led to discussion about the nature of aphasia, par-
ticularly the wider social implications and the value
of communication methods such as symbols.
Parliament petitioned on aphasia
Speaking
about
aphasia
Speak About Aphasia month aims
to raise awareness among health
and social care staff, service indus-
tries such as banks and transport
providers, and the general public.
Organisers Speakability want to get
as much publicity as possible so that
more people understand about
aphasia and can give the quarter of
a million people with aphasia in the
UK the support they need.
Speak About Aphasia month runs
from 18 May - 16 June, 2002.
www.speakability.org.uk,
tel. (admin) 020 7261 9572.
Speech and language therapist Joyce Seaward
commented, It takes courage for people with
aphasia to come here and speak. For example, no
ramps have been provided for them and we have
not slowed down the meeting. We have not been
allowed to write things in advance. They have
done the hardest thing. It is like asking someone
with one leg to somehow get up the stairs to this
committee room. Aphasia is a largely invisible dis-
ability. Kim Hartley of the Royal College of Speech
& Language Therapists followed up with a plea for
more adequate and equitable provision of speech
and language therapy services in primary and sec-
ondary care.
The petition asks the Parliament to recognise that
aphasia is a life-disabling condition, to develop and
produce accurate measures of aphasia in Scotland,
improve the quality of service to people with apha-
sia, and support service development based on
accurate measures of need and performance. In
addition, it calls for adequate funding and guid-
ance to ensure that measures are put in place to
meet the needs of people with aphasia through
adequate training of health and social care
employees, improved access to speech and lan-
guage therapy and new treatment and support
packages at all stages, from acute treatment to
long term rehabilitation. The committee promised
to keep the petitioners up to date with action
taken.
Full text on www.scottish.parliament.uk.
Apology for horrendous inconvenience
Speech & Language Therapy in Practice has received a full apology and compensation
for costs incurred through faulty surcharging of renewal letters by Royal Mail.
Over 20 per cent of subscribers sent renewal letters in March were incorrectly charged
64p, and many faced the inconvenience of having to travel to collect their letters at a cen-
tral depot. Those affected have hopefully all now been compensated by us, but should
note the following explanation in a letter from a Customer Service Advisor in Aberdeen:
...It would appear that the surcharging was done on a Saturday when there were no
Revenue Protection staff on duty. The surcharging was also done with scales that need-
ed re-calibrating. Revenue Protection were aware that they were inaccurate but regret-
tably the member of staff on duty when your items of mail were surcharged was not.
I can confirm that all scales in the building have been checked and the situation will not
arise again as all surcharging is now the sole responsibility of Revenue Protection.
I can only sincerely apologise for this horrendous inconvenience you have suffered.
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 3
news & comment
A sense o
drecton
An e-mail from a reader asks what has really happened to the profession in
the thirty years since the Quirk report. Are we going somewhere or have we
seen it all before?
My final year project was on using computers with people with aphasia. At
that time there was one textbook, a handful of small research projects and a
general dearth of hardware and software. Fourteen years on we are still not
anything like exploiting the potential of computers but, with therapists like
Julia Wade and Sarah Woodward (p13) plugging away, we will hopefully see
a lot of movement over the next few years. Much of this will be demand-led
by our clients with aphasia who are finding new ways of expressing their
dissatisfaction with services and ideas for improvements. The Scottish
Parliament petitioners (see news report on p2) demonstrate how users, the
voluntary sector and professionals are beginning to work together to make
their needs heard and understood.
Working in schools really did at one time mean withdrawing individual
children from their classroom at twenty minute intervals to sort out minor
speech sound problems in a broom cupboard. Myra Kersner and Ann Coxon
(p22) look into what is happening now, and find services trying to change to
live up to the ethos of inclusion in spite of coming across as many barriers to
new ways of working as there are to inclusion itself.
In Barnsley, collaborative working is being adopted with enthusiasm and direct
client contacts correspondingly reduced. Clair Brookes and Tracey Marsh (back
page) tell me they found the opportunity to reflect on what they do a very
positive experience. Similarly, Lucy Wood (p20) finds that helping potential
recruits make informed decisions about whether speech and language therapy
is the career for them reminds her why she joined the profession in the first place
and why it is still the place she wants to be. Tracy Robertson and Wendy McKennas
work on care protocols (p18) is particularly relevant for empowering new
graduates and giving them a sense of direction while leaving room for flexibility.
The How I manage stammering in adults contributors (p25) all have considerable,
long-term experience in their field, which has given them the opportunity to
learn from clients over time how their needs change. Stammering is one of
many areas where the profession is opening up more to accepting that not
only speech and language therapists can help people with communication
difficulties. Particularly with recruitment, retention and resourcing as they
are, we should consider working with non-NHS ventures to benefit our
clients. Nibbhaya (p4) has experienced the value of meditation both personally
and clinically and recommends we consider involving teachers of meditation
to help specific clients. Patricia Sims (p8) is now finding the theories she
developed through practical experience in the NHS are able to be fulfilled in
her independent work where she can offer realistic amounts of therapy to
motivated individuals and their parents and liaise with schools as necessary.
In an age of evidence based practice, the articles in this issue suggest things
on the ground are changing. So, if youre looking for a sense of direction,
take a trip down memory lane and see how far youve come.
...comment...
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Knnear Square
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Dyslexia competition
A national competition aims to give young people
with dyslexia the opportunity to demonstrate
their natural creative strengths through writing,
art, video and photography.
As I See It, with the themes of Communicating
through the ages or My hero, is organised by
the Dyslexia Institute (tel. 01784 463851) and the
British Dyslexia Association (tel. 0118 966 2677).
Open to people with dyslexia aged 18 and under,
the competition has a closing date of 31st July,
2002 and cash and camcorder prizes.
www.asiseeit.co.uk.
Early years
accreditation scheme
A new accreditation scheme sets the UK standard for
integrated therapy and education for children up to
five years with speech and language impairment.
I CAN, the national educational charity for children
with speech and language difficulties, has
launched the scheme for providers of early years
services for children who have difficulty commu-
nicating. It will build on the expertise of I CANs
expanding Early Years Network which has been
shown to greatly benefit preschool children with
persistent speech and language impairment.
Details from I CAN, tel. 0870 010 40 66.
Raising profile of MND
Motor Neurone Disease is getting a higher politi-
cal profile with the establishment of an All-Party
Parliamentary Group.
The group is expected to meet four times a year
with the aim of raising the profile of motor neurone
disease, providing a political forum for discussion
and debate and opening a channel of communica-
tion between those affected and the government.
Three people a day die from motor neurone dis-
ease in the UK and average life expectancy is just
14 months after diagnosis.
National helpline 08457 626262.
Computer research
A research project will look at the use of auto-
matic speech recognition software by people with
aphasia following a stroke.
The 46,000 grant from the Stroke Association to
Professor Pam Enderby will fund a study to investi-
gate whether clients will be able to use the software
to write using a computer or e-mail. In addition,
the Bristol research team will look at which clients
are likely to benefit the most and will make recom-
mendations to guide potential users in choosing
software appropriate to their needs.
The Stroke Association is also reporting that the
Step-by-Step program, the result of a project it fund-
ed at the Speech and Language Therapy Research
Unit in Bristol, should be available to speech and
language therapists by September 2002. The soft-
ware, to be used at home via the internet, needs an
average of one and a half hours a month input from
a speech and language therapist for an average of
15 hours of computer therapy for the client.
www.stroke.org.uk; Steps Consulting Ltd, tel.
01249 783007, e-mail jane@stepstherapy.co.uk.
cover story
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 4
erhaps the first thing you notice about
another person when you meet them is
whether they are with you or not. This
skill of engaging in your topic of thought
and conversation is known as joint or
shared attention (Ellis, 1990). An example of suc-
cessful joint attention is when a child looks at a
toy, then makes eye contact with an adult, smiles
then looks back at the toy as if to say, Look at this
great toy or hey you, I like this.
When a child enters education they are required
to have the skill of joint attention because they
need to attend to the topics chosen by teachers.
Some children do not have this listen and do skill
at school entry. Reynells developmental frame-
work of attention (1980, see figure 1) is frequent-
ly used by speech and language therapists when
deciding to treat delays in attention development
associated with a communication difficulty. Often
the attention of a child with a delay is single
channelled. Treatment including sound lotto,
sound matching, comprehension and memory
games is aimed at gaining and sustaining the
childs attention until they can follow instructions
of a certain length.
Children with autism have been described as
having tunnelled attention (Jordan, 1997).
Superficially, the presentation of children with
either single channelled or tunnelled attention is
the same. To use a Hanen term (Manolson, 1992),
they both have their own agenda. However, autis-
tic childrens attention sometimes appears to be
strongly influenced by their interest. Attention
span can be of very long duration and is therefore
disordered rather than delayed.
GN is a child with tunnelled attention. She has
a restricted range of interests, particularly liking
rabbits. In free play it is very difficult to share her
games because her attention is on one thing to
the exclusion of others. She is insistent about the
type of play and there is very little sharing of
interest.
I observed a quite different quality of attention in
DS, a child diagnosed with autism. (This was before
June 2001 when I was given a Buddhist name,
Nibbhaya, to replace my old name of James.)
When DS saw me in school he said, James,
James Bond, and went on to make connections
about the fictional character. He also said
hello, but could not sustain his attention to my
response long enough to take another turn. His
attention rested only briefly and lightly on me.
There was no joint attention, and he seemed
vague or not present, his attention drifting in
verbalised free association.
Descriptive model
Having observed qualities of attention control
other than those described in the literature, I
decided to develop a descriptive model to cover
them, as more specific descriptions should lead to
more awareness about attention control and
more specific treatment strategies.
The spiritual practices of meditation and reflection
are ways of cultivating and sustaining attention
and could give clues to finding suitable methods
of describing attention control. Sangharakshita
(1980), a Buddhist with fifty years of meditation
P
you want
a cnca too or
attenton contro
to engage wth your
cents
to ke other peope
more
Read this
Sandwell speech and language therapist Nibbhaya
contemplates the skills involved in attention control
and shares his work in progress, a new model for
clinical use. Although his inspiration comes primarily
from children with autism, the model can be applied
to any client group - and to ourselves.
Attention
-your firm and
flexible friend
Nibbhaya
Picture posed by model (see p1)
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 5
cover story
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lANGUAGE
Ganschow, L., Philips, L. & Schneider, E.
(2001) Closing the gap: accommodating stu-
dents with language learning disabilities in
college. Topics Lang Disord 21 (2), 17-37.
This article describes language difficulties of
college students with language learning dis-
abilities (LLD) and the types of accommoda-
tions that are provided to these students.
First, it presents four language issues that
affect the provision of accommodations. It
points out that there are differences across
universities in the accommodations offered
and stresses the importance of matching
the student to the university that can provide
accommodations appropriate to the students
needs. It presents three case studies of stu-
dents who vary on a continuum of severity of
language problems, describes accommodations
provided for each, and presents two perspec-
tives on accommodationsthat of the LD ser-
vice provider and that of faculty who taught
the three students. The article suggests ways
for speech-language specialists to collaborate
on a high school transition team and with the
LD Coordinator at the university. (34
References)
NON-VERBAl
Stallard, P., Williams, L., Lenton, S. & Velleman, R.
(2001) Pain in cognitively impaired, non-commu-
nicating children. Arch Dis Child 85 (6), 460-2.
AIM: To detail the everyday occurrence of
pain in non-communicating children with
cognitive impairment. METHODS: Thirty four
parents of cognitively impaired verbally non-
communicating children completed pain
diaries over a two week period. Each day, for
five defined periods, parents rated whether
their child had been in pain, and if so, its
severity and duration. RESULTS: Twenty five
(73.5%) children experienced pain on at least
one day, with moderate or severe levels of
pain being experienced by 23 (67.6%). Four
children (11.7%) experienced moderate or
severe pain lasting longer than 30 minutes on
five or more days. No child was receiving
active pain management. CONCLUSIONS:
Everyday pain in children with severe cogni-
tive impairment is common, yet is rarely
actively treated.
PAlllATlVE ARE
Frost, M. (2001) The role of physical, occupa-
tional, and speech therapy in hospice:
patient empowerment. Am J Hosp Palliat
Care 18 (6), 397-402.
The use of physical, occupational, and speech
therapy is a growing trend in hospice. The
purpose of this paper is to define the role of
the physical, occupational, and speech thera-
pist as part of the hospice team in the context
of the various therapies objectives. A case
study is presented and clinical implications
are discussed. (19 References)
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 13
computers
hatever we as therapists feel about them, computers are here
to stay. We are increasingly being asked about the possibili-
ties of using a computer in therapy. But how does a busy clin-
ician keep abreast of new software that becomes available so
as to be able to respond to this in an informed and informa-
tive way? And, given that software resources specific to individual client groups are
limited, could we be borrowing more from what is available to other client groups?
Software reviews which evaluate the potential for application in speech and lan-
guage therapy do exist. Wren (2001a; 2001b) provides a review of software for work-
ing with children which was carried out as part of the Hear IT, Sound IT project to
develop software appropriate for working on phonological difficulties in children.
The Software Evaluation Booklet produced by the Aphasia Computer Team (1999) at
the Speech and Language Therapy Research Unit at Frenchay Hospital reviews soft-
ware appropriate for people with aphasia. It covers some of the most widely known
software such as INTACT, REACT, Parrot and Bungalow (see resources) as well as some
recreational and word-processing software. The evaluation process involved people
with aphasia giving their views.
Therapists often report frustration at the limited choice and quality of specialist
aphasia software available, not to mention the cost. The number of software titles
designed specifically for aphasia therapy, though growing, is still limited and is small
compared to the number designed for the education sector in general. This article
therefore draws attention to the fact that software designed for other groups may
nonetheless by useful to people with aphasia. We review a limited selection of seven
titles (My House, Smart Start English, Speech Sounds on Cue, Jigsaw, Co:Writer, Clicker
4 and Out and About), none specifically designed for users with aphasia, and demon-
strate in what ways these may be useful to them.
There is a risk in any evaluation that the software reviewed is quickly superseded.
We hope that our explanation of our evaluation protocol will enable readers to apply
evaluation procedures independently, thus keeping abreast of innovation. In review-
ing non-specialist software, we want to encourage readers to think broadly when it
comes to software resources.
The task of systematically reviewing software taken from such diverse categories as
therapy software, word processing software and recreational software is a challeng-
ing one and inevitably results in distilling information to a summary. However, 10
questions were borne in mind when developing the evaluation protocol:
1. What language tasks are targeted?
Software may target auditory language comprehension, written language compre-
hension, speech sound production, word processing skills or visual skills. Just as with
conventional therapy programmes, it is likely that you will get most from the software
by picking and choosing aspects suitable for individual clients.
2. What is the intended client group and what other client groups
may benefit?
Some software (for example, My House) has been designed primarily for children and
uses cartoon type drawings, but may be useful with other client groups. If you have
reservations regarding the suitability of software for adult clients, demonstrate it,
explaining it was designed for use by children as well as adults, and let the user decide
whether it is acceptable or not. Even if aspects of the software are clearly appropri-
ate, you may need to select and leave out those that are not. Certain parts of Out and
About, which is designed for people with learning difficulties, are appropriate for
people with head injury but will not necessarily be appropriate for people with apha-
sia following a stroke.
you want to
keep abreast o
normaton technoogy
open up new
opportuntes or cents
oer therapy at both
mparment and
unctona eves
Read this
With the range of software for
people with aphasia limited,
Julia Wade and Sarah Woodward
use an evaluation protocol to
check out packages designed for
other markets. So, have you
embraced the age of
information technology?
Or is IT still just a pronoun in
capitals? Whatever your level of
experience and client group,
read on to wise up to the
potential of computers.
v
Adapted word
processing
software designed
for all ages with
limited literacy skills
Stroke, head injury,
learning difficulties
Crick software
90
W95, soundcard
Low-mod
Speech and language
therapy software
designed for the learning
disabled for work on all
areas of auditory
language and memory
Stroke, head injury,
learning difficulties
Semerc
59 (20 home
licence)
W95, soundcard
Low-mod
Adapted word
processing
software designed
for all ages who
need some help
with their writing
Stroke, head injury,
learning difficulties
Don Johnston
149
W95, soundcard
Mod-high
Software for doing
jigsaws on the
computer for all
ages
All
Crick software
30
W95
Low-mod
Speech and
language therapy
software designed
for work on
dyspraxia
Dyspraxia
Propeller
Multimedia
90
W95, soundcard
Low
English as a foreign
language software
designed for any
learner to work on
English language
skills
Stroke, head injury,
learning difficulties
AVP
34
W95, soundcard,
SVGA video card
High
Speech and
language therapy
software designed
for children to
work on auditory
comprehension
Stroke, head injury,
learning difficulties,
developmental
language
Laureate Learning
129
W95, soundcard
Mod
p.16
Ratings key: 0 = none
* = poor
** = good
*** = excellent
Input device key: M = mouse
K = keyboard
T = touchscreen
S = switch
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 15
computers
Figure 2 Case example
Background
J, a 73 year old lady who had a left cerebrovascular
accident about 18 months ago, was referred to the second
author who provides a Computer Assessment and Training
service from Frenchay Hospital to support clients and
therapists in using computers in therapy. She has aphasia
and dyspraxia, which have severely affected her spoken and
written output. She is ambulant around the house, but
needs a wheelchair to get about for longer trips. She has
good functional use of both her hands.
Communication history
Js levels of comprehension are compromised in formal
assessment but rarely affect her social and functional
communication. Her speech is very limited and the few words
she has are often difficult to understand due to her dyspraxia.
Her writing is restricted to initial one to three letter spelling.
She reads well at sentence level. She is an active participant in
all communication settings.
Current communication
J is a very sociable, confident and effective total communicator.
She rates well in terms of communicative competence and uses
her various strategies to respond, ask questions, initiate new
topics and indulge in general banter. However she obviously
has frustrations. J uses a combination of spoken single words
augmented with lots of clear, functional gesture; pointing; use
of a communication book; use of a diary; use of a dictionary;
and writing (initial one to three letter spelling). She has excel-
lent levels of attention and concentration, and
demonstrates good potential for new learning.
Speech and language therapy input
When J was first referred, she was working on improving her
writing at a single word level, improving her reading at
paragraph level and increasing her speech output.
Previous computer knowledge
J had never used a computer before and indeed was extremely
nervous about doing so. Her husband felt similarly. Her speech
and language therapist had some limited experience of using
computers, but did not feel certain of how to introduce them
into Js therapy.
Reason for referral
J was referred to us by her speech and language therapist
because she appeared to have so much potential and was so
eager to try everything possible to increase her communication
abilities.
Js aims:
to learn how to use a computer
to then use the computer to work on the same areas as in
speech and language therapy sessions, independently
to increase leisure opportunities
to improve written output.
Software we looked at
1. REACT (specific speech and language therapy language programme): We looked at
using this for work on reading comprehension, spelling and whole word sentence
building.
2. Co:Writer (word prediction package): We examined this to see if J could use her
initial letter spelling and whole word reading to generate some of her own writing.
3. Clicker (supportive writing tool): We considered using this for work on sentence
building skills in a functional way (writing cards and letters).
4. WAPS (basic keyboard familiarisation): We looked at this to see if it would help J
practise finding her way around the keyboard.
With help from the local speech and language therapist, we put together a therapy
programme using a combination of three of these software packages (WAPS, REACT and
Clicker) which J would find motivating and of immediate functional use. The aim was
for her to improve skills on some packages while putting these new skills to functional use,
for example when writing cards and letters. Long-term, we will review progress with
spelling and sentence structure with a view to introducing the fourth package (Co:Writer).
We set up a loan computer at Js home and trained J and her husband in
operating the various packages. We left a folder with detailed, user-friendly, step by
step, picture supported instructions for them to follow.
Outcome
J and her husband quickly became familiar with the operation of the computer and the
layout of the keyboard. J was able to find her way in and out of the software packages
and the various exercises we had set her with ease. J and her husband only needed
one session of two hours to be using the computer independently (bearing in mind NO
previous experience). This was followed by four home visits each lasting 1
1
/2 hours.
Within a month they were eager to purchase their own computer and three months
after they had first set foot in the computer assessment and training service they were
fully set up with their own PC (personal computer) and printer.
J now uses the computer daily for:
working on her spelling and sentence building skills
writing her Christmas (and now starting on her Easter) cards
writing to her family who live far away
carrying out new hobbies such as making cards and playing games on
the computer. (J and her husband have now purchased various
software packages themselves which they have figured out how to use
with minimal help.)
J and her husband have also attended free IT lessons at the local library to boost their
skills and confidence. J feels extremely proud of her achievement given her age, lack
of previous experience and language difficulties. She has mastered something
without difficulty that others, without any language impairment, are still challenged
by. She feels it has helped her work independently on certain skills thus giving her
more therapy. She also feels it has opened up new pastimes for which she is grateful
given that, like many people in her situation, a lot of her previous hobbies such as
gardening and cooking are now impossible to realise.
During a course run by the second author
and Alex Davies in June, many delegates
expressed an interest in forming a
Computer SIG. This could provide a useful
forum for the exchange and brainstorming
of ideas and equipment. If you would be
interested, contact us:
Sarah Woodward, tel. 0117 9701212 x
2241, e-mail comptraining@linone.net
Alex Davies, tel. 0117 9754834, e-mail
alex.davies@north-bristol.swest.nhs.uk.
Frenchay Hospital, Bristol, BS16 1LE or at
www.speech-therapy.org.uk.
Wren. Y. (2001a) Software and Speech - a review
of software in phonology therapy. International
Journal of Language and Communication
Disorders 36 supplement, 487-492.
Wren, Y. (2001b) Childrens software evaluation
for Hear IT - Sound IT Research Project. Available
on request from the Speech and Language
Therapy Research Unit, Frenchay Hospital, Bristol,
BS16 1LE or at www.speech-therapy.org.uk.
Resources
Bungalow Software, see www.bungalowsoftware.com.
Clicker 4 from Crick Software, 35 Charters Gate,
Quarry Park Close, Moulton Park, Northampton
NN3 6QB, tel. 01604 671691, www.cricksoft.com.
Co:Writer from Don Johnston Special Needs, 18/19
Clarendon Court, Calver Road, Winwick Quay,
Warrington WA2 8QP, tel. 01925 241642,
www.donjohnston.com.
INTACT from Aphasia Computer Team, Frenchay
Hospital, Bristol BS16 1LE, tel. 0117 918 6529,
www.speech-therapy.org.uk.
My House series by Laureate Learning Systems, Inc.
From Rompa, Goyt Side Rd, Chesterfield, Derbyshire,
tel. 0845 3000 899, www.laureatelearning.co.uk.
Parrot Software, see www.parrotsoftware.com.
REACT and Speech Sounds on Cue from Propeller
Multimedia Ltd, PO Box 27028, Edinburgh EH10
6WD, tel. 0131 4460820, www.propeller.net.
SEMERC, Granada Learning Ltd, Granada
Television, Quay Street, Manchester M60 9EA, tel.
0161 8272927, www.semerc.com.
Smart Start English from AVP, School Hill Centre,
Monmouthshire NP6 5PH, tel. 01291 625439,
www.avp.co.uk.
computers
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 16
REVIE
PAEDIATRICS
HELPFUL KEY POINTS
Speech and Language Therapy
(The Decision-Making Process
when Working with Children)
Edited by Myra Kersner and
Jannet A.Wright
David Fulton Publishers Ltd.
ISBN 1-85346-668-9 25.00
This book addresses the everyday decision-
making processes that speech and language
therapists face when assessing and managing
children. It starts by describing a framework
for the processes involved, which is then
applied to different work settings and a vari-
ety of client groups. Working with other pro-
fessionals and parents is also included.
Each chapter covers a different specialism
and is by an expert in that field. They pro-
vide clear details with helpful key points.
Terminology is clearly defined and learning
outcomes highlighted.
It is especially relevant to and a useful refer-
ence point for students, newly qualified
therapists, plus returners (and anyone super-
vising them). A valuable addition to any
speech and language therapy department.
Philippa Fieldson is a returner working as a
speech and language therapist for
Worcestershire NHS Trust.
APHASIA
A WELCOME RESOURCE
Phonology Resource Pack for
Adult Aphasia
Sarah Morrison
Speechmark ISBN 0 86388 228 5
85.00
This will be a welcome resource to all therapists
who like to offer psycholinguistically motivated
impairment therapy. The pack consists of five
ring bound A4 booklets providing a substantial
body of therapy exercises aimed at developing
the phonological skills of people with aphasia.
Most exercises are rhyme judgement tasks
based either on pictures or written words.
Others involve homophone judgement and a
degree of phonological segmentation. There
are no syllable number judgement exercises
(the sales blurb describes the pack as being
comprehensive, always a dangerous claim!)
The pictures are line drawings presented in a
gently humorous style and photocopying is per-
mitted. The generous appendix allows for pre-
exercise familiarisation and the consistency of
format between exercises makes it easy to use.
Therapists working in an outpatient or rehab
setting will certainly get their moneys worth.
Jon Hunt and Lauren Caris are speech and lan-
guage therapists with North Bristol NHS Trust.
word processing. No score representative of accu-
racy rate is given in the Jigsaw software.
8. Does the software allow the therapist
to customise the menu options available
to the user?
My House gives the option of an exploring or a
testing mode for the user and allows customisa-
tion of response time. Smart Start does not allow
any customisation so the full suite of exercises is
always available to the user. Out and About has a
totally customisable menu facility so that anything
from one to eight exercises can be made available.
9. Does the software have an authoring
component to allow the clinician to
create their own exercises?
This allows the flexibility of targeting material
that is personally relevant. Jigsaw lets the thera-
pist use scanned or digital photos. Clicker 4 allows
for personalised words, phrases and pictures to be
inserted into the users grid from which users then
select relevant items to build up sentences in a
separate word processing window.
10. Does the program allow for
different input devices to be used?
My House, Jigsaw and Clicker 4 can all be accessed
by people unable to use a keyboard or mouse
(that is, using a touchscreen or a switch). A lot of
people with any kind of upper limb weakness will
find a tracker ball easier to use than a mouse.
The summary of evaluations is in figure 1 (p. 14).
It shows that, as in conventional table-top thera-
py, no one therapy activity is sufficient to target
any individuals needs, and activities become most
effective when functional gains are the main goal.
The case example (figure 2, p.15) illustrates how
different software can be used concurrently by one
person with aphasia to target their language diffi-
culties at both impairment and functional level.
Both authors are speech and language therapists
working for North Bristol NHS Trust at Frenchay
Hospital. Julia Wade (tel. 0117 918 6529, e-mail
julia@speech-therapy.org.uk) works in the Speech
and Language Therapy Research Unit, investigat-
ing use of computers in aphasia therapy. Sarah
Woodward (tel. 0117 970 1212 ext 2241, e-mail
comptraining@lineone.net) provides a Computer
Assessment and Training service from Frenchay
Hospital to support clients and therapists in using
computers in therapy.
Acknowledgement
To Alex Davies and Jane Mortley for their contri-
butions to the Software Evaluation Booklet and
the evaluation protocol on which our evaluations
were based.
References
Aphasia Computer Team (1999) Software
Evaluation Booklet. Available on request from the
Speech and Language Therapy Research Unit,
Do I need to invest more time
and resources in computer
based therapy?
Do I consider how therapy
materials designed for one
client group can be adapted
for another?
Do I encourage clients to take
advantage of community
education opportunities?
Reflections
1. consider operating a
multi-site service from
a central resource
2. work with colleagues in
other professions to
produce a written policy
on collaboration
3. provide other
professionals and
parents / carers with
evidence-based
information on styles
of working
4. apply for funding to
develop work with and
training of support staff
5. give students the
opportunity to
experience work in
different environments.
Five steps to
better practice
1. Assess overt and covert behaviours, reactions and coping strategies.
2. Adapt to individuals, using a mix of approaches and time-scales.
3. Highlight the strengths and resources clients have within themselves.
4. Shift a clients focus from cure to maintainable progress.
5. Pace the flow of information.
6. Use rating scales as therapy tools and outcome measures.
7. Ensure techniques can be incorporated in real life.
8. Empower clients to manage their own communication over time.
9. Let clients know it is OK to have set-backs and to return for help.
10. Take opportunities to share skills with non-NHS ventures.
P
r
a
c
t
i
c
a
l
p
o
i
n
t
s
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 25
how I
l manage
stammerng n
aduts
Stammerng n aduts and The NcGure
Programme have receved a great dea o
pubcty recenty through Gareth Gates rom
teevsons Pop ldo. Athough Gareth hmse
has nspred many young peope wth
communcaton dcutes, t s debatabe how
much the nature o the meda exposure has
ncreased understandng and acceptance o
stammerng - n peope wth a stammer as we
as n the non-stammerng pubc.
Has the message got across that stammerng s
a mutactora and compex phenomenon'
That there s no known cure' That peope have
the rght to be heard whether or not they
stammer' Nost mportanty, do peope now
apprecate that the management o stammerng
n aduts needs to be hostc and taored to an
ndvduas needs and wshes - and that
overcomng a stammer means derent
thngs to derent peope' Three peope who
understand ths more than most share
ther experences.
Louise Wright, formerly of the
Manchester Metropolitan
University, is now specialist
speech and language therapist
in dysfluency and Sure Start
Lescudjack with West Cornwall
Primary Care Trust.
Claire McNeil is a specialist
speech and language therapist
in dysfluency with Swindon
Primary Care Trust.
Anne Blight started training as
a speech therapist but, feeling
there was not enough
in-depth work for stammerers,
got involved as a volunteer
instead. Excited by the
potential of diaphragmatic
retraining - but disillusioned
with the way it was being
introduced in the UK - she
founded the Starfish Project in
1998 as a non-profit making
venture aimed at helping
adults and young people
recover from stammering.
you want to
oer therapy taored to
ndvduas
be postve and reastc
about prognoss
equp cents to manage
ther own communcaton
Read this
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 26
how I
have worked with people who stammer (of all ages) for the
past 22 years and find it as enjoyable and challenging now as
when I first started. I worked for 11 years in the NHS, latterly
as a specialist in dysfluency, moving on to teach disorders of flu-
ency at undergraduate and postgraduate levels at the Manchester
Metropolitan University. Whilst there I also ran a weekly special-
ist dysfluency clinic supervising students, and carried out research
into employment and family issues for adults who stammer.
I have worked with adults who stammer individually, in weekly
groups, in the workplace involving managers and colleagues, in
intensive groups and also on residential intensive courses
involving families and friends. Anne Ayre and I developed The
Wright and Ayre Stuttering Self-Rating Profile (WASSP, 2000) as
an outcome measure for therapy with adults who stammer as a
result of our work with adults in the workplace (Ayre et al,
1998) and I use this as a tool both to plan and evaluate therapy
outcomes.
My approach to therapy is influenced by a number of over-arching
principles. I always work with the clients stammer within the
context of him or her as a person. I adapt my approach to suit
their personality, lifestyle, impact of their stammer on their life,
experience of past therapy and their readiness for change
(Prochaska & Di Clemente, 1986). I do this by taking time to get
to know them, listening to them and involving them in therapy
decisions by explaining possible options, experimenting and
evaluating the results. I see stammering therapy as a long-term
process of change that may impact on many areas of their lives.
Exploratory
I begin to understand them and their stammer through an ini-
tial semi-structured interview (severity of the stammer permit-
ting) and I may follow this up later with additional exploratory
tools such as the S-24 Attitudes to Communication Scale
(Andrews & Cutler, 1974), Locus of Control of Behaviour Scale
(Craig et al, 1984) and Self-Characterisation (Kelly, 1991).
I always aim to address the overt and covert aspects of the clients
stammer, their reactions to stammering and their current coping
strategies. I use WASSP to explore the following aspects of their stam-
mer and to obtain a baseline self-rating measure from which we can
measure change following a block of therapy. WASSP includes:
Stammering behaviours including frequency of stammers,
amount of physical struggle or tension during stammers,
urgency or fast speech rate, associated physical movements made
as a reaction to stammering, general level of physical tension,
eye contact and any other behaviours which are significant.
Negative thoughts about stammering before, during and
after stammering.
Feelings about stammering such as frustration, embarrassment,
fear, anger, helplessness.
Avoidance as a coping strategy at the levels of words, situations,
talking about stammering with others and admitting their
problem to themselves.
Disadvantage experienced at home, socially, educationally
or at work as a result of their stammer.
I will usually ask the client to complete WASSP at the end of
the initial interview when they have spent some time reflecting
on and discussing aspects of their stammer which they may not
have considered for some time, if ever. The client at this point
records their aims and expectations of therapy.
Use of WASSP also helps me to illustrate which areas therapy will
address and where they may expect change to occur. Some clients
are surprised that I am not just going to address the mechanics of
speech. Others are relieved that I understand the complex multidi-
mensional nature of stammering and will be helping them to
address it on many levels. For many it is the first step in under-
standing their stammer and how therapy is going to work.
At the end of the first meeting I will describe possible thera-
py options that will help them to achieve their aims. If they
Gettng
to know
you
Stammerng
therapy s a
ong-term process
o change that may
mpact on many
areas o a
stammerers e.
But s your cent
ready to change'
Do they have
sucent support
n the workpace
and at home'
vhat approach(es)
woud work best
or them'
louse vrght
expans her
decson-
makng process.
have a stammer with mixed overt and covert components but
with some natural fluency I might suggest Van Ripers approach
of initial identification, desensitisation and variation leading up
to modificaton of the stammer (Van Riper, 1973). I tend to
favour Contures simpler version of stammering easily by mov-
ing through stammers (Conture, 1990) rather then Van Ripers
different types of modification. If the client is very fluent with
high levels of anxiety about stammering and frequent avoid-
ance then I would suggest Sheehans avoidance reduction ther-
apy (Sheehan, 1975) with easy introductions to voluntary stam-
mering and sliding. However, if they are stammering very
severely our first option may be a fluency technique such as
slowed speech that will give them more fluency initially and can
later be augmented with easy stammering techniques (Neilson
& Andrews, 1993). Whatever path is finally embarked upon I
usually find it helpful to begin therapy with a period of identi-
fication and understanding of normal speech production.
Mixture
Although I would normally outline these three main therapy
options to the client at the end of our first exploratory session,
in reality of course most clients require a mixture of these types
of therapy, either simultaneously or sequentially as their stam-
mer changes and their therapy needs evolve. WASSP can again
be helpful here in monitoring progress, discussing change and
planning new phases of therapy with the client.
In getting to know the person it may become apparent that
they would also benefit from help with wider aspects of com-
munication such as improved social skills, assertiveness training,
anxiety management, relaxation, cognitive-behavioural coun-
selling and problem solving. They may benefit from a mix of
individual therapy, various types of group therapy and involve-
ment of significant others depending upon their needs and rate
of progress. Clients usually attend on a weekly or fortnightly
basis interspersed with breaks to consolidate change and take
responsibility for their own maintenance and therapy problem
solving. Long breaks are appropriate when the client decides
that therapy has fulfilled their needs for the present and they
always have the option of stepping back into therapy should
their needs change.
My aim in all therapy is to empower the client to manage their own
stammer long-term, by helping them to acquire the understanding,
therapy tools and confidence needed to react to their changing
needs and circumstances. If those around them at home and at work
can also understand their stammer and how they are dealing with it,
I believe that the person who stammers is more likely to manage and
maintain change and those around them are more likely to feel com-
fortable and positive about the stammer and therapy.
References
Ayre A., Wright, L. & Grogan, S. (1998) Therapys Long Term
Impact on Attitudes Towards Stuttering in the Work-place. In:
Healey, E. & Peters, H. (Eds) 2nd World Congress on fluency
Disorders, 18-22 August 1997, San Francisco, 403-406.
Nigmegen University Press, Nigmegen.
Andrews, G. & Cutler, J. (1974) S-24 Scale. Stuttering Therapy:
The Relations Between Changes in Symptom Level and
Attitudes. Journal of Speech and Hearing Disorders 39, 312-310.
Conture, E. (1990) Stuttering (Second Edition). Prentice Hall,
Englewood Cliffs, New Jersey.
Craig, A., Franklin, J. & Andrews, G. (1984) A Scale to Measure
Locus of Control of Behaviour. British Journal of Medical
Psychology 57, 173-180.
Kelly, G. (1991) The Psychology of Personal Constructs.
Routledge, London.
Neilson, M. & Andrews, G. (1993) Intensive Fluency Training of
Chronic Stutterers. In: Curlee, R. (Ed) Stuttering and related
Disorders of Fluency. Thieme, New York.
l
Harper and Row, New York.
Van Riper, C. (1973) The Treatment of Stuttering. Prentice Hall,
Englewood Cliffs, New Jersey.
Wright, L. & Ayre, A. (2000) WASSP: The Wright and Ayre
Stuttering Self-Rating Profile. Speechmark, Bicester.
SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002 27
how I
n Swindon we have a specialist Fluency Service with four
speech and language therapists working part-time. We see
all ages and run intensive residential courses for children
and teenagers. I have worked in the area of stammering
for the past 15 years. During this time ways of thinking and
types of therapy have tended to come and go. I feel privileged
to work with adults who stammer and have met and learnt
from many fascinating and brave individuals. The uncertainties
in the causes of stammering and its variability make it a chal-
lenging area of work. I use a range of therapy approaches but
have been influenced greatly by learning more about Neuro
Linguistic Programming (NLP) and brief therapy. I have not given
up my old favourites of block modification, breath control and
relaxation strategies, but tend to mix the ideas and approaches.
The great thing about working in this area is that you can keep
asking, how is it going?, how are you finding this approach?
and gain instant feedback, something not possible in areas where
clients are unable to communicate with us so directly. The influence
of NLP is evident in my initial assessment where my priority is to
build rapport. My aim is to understand as much as possible about
the meaning and the experience that stammering has for the indi-
vidual, to see it through the clients frame of reference. I aim to get
a sense of how the person learns - are they mainly visual, auditory or
kinaesthetic in the way they use information? This helps us select the
kind of therapy activities that will create changes for the individual.
In NLP the therapist is aiming to create the conditions where-
by the client may choose to change and find new and interest-
ing ways to carry out these changes (Bailey, 2001). I also take
the usual case history, gathering information about the nature
of the individuals stammering, both overt and covert features.
During this process I look for clues to help understand the
meaning all this has for the individual.
Pace the flow
Something I have learnt with experience is to try to pace the flow
of information. At one time, following the principles of block
modification during its phase of identification, much time was
spent analysing behaviours and covert symptoms. Whilst this
information is necessary, I feel that to do too much of this straight
away can be daunting for the individual, and I am sure I have lost
some clients in the past through too much analysis, too soon.
Trying to get a balance between identifying the problems and
looking for solutions early on in therapy is important. It is at this
point that the ideas of brief therapy really help. Also known as
solution focused brief therapy, it looks at the clients hopes for
the future. Rather than trying to understand and fix problems,
it works by charting your way forward and seeking the resources
needed to embark on the journey. The essence of it is to:
work with the person rather than the problem.
look for resources rather than deficits.
explore possible and preferred futures.
explain what is already contributing to those possible futures.
treat clients as the experts in all aspects of their lives.
(Taken from a Brief Therapy Practice course.)
Bearing this in mind, when dealing with the initial assessment
I try to take history details so as not just to get a picture of what
has gone before, but also to encourage the client to express
their preferred future. Looking for the clients strengths and
resources is extremely helpful right from the first session.
I like to use scales as part of outcome measures. The client is
asked to consider what they would like to achieve as a result of
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the work we will do together - their preferred future. Then, on
a scale of 0 - 10, I ask Where are you now?, How will you
know when you have moved up just one point on the scale?,
What will you notice?, How have you managed to get to
where you are now? Clients very rarely put themselves at 0, so
they are already some way up the scale. One particular client
said he had been feeling very depressed and could not see anything
positive in his life. When we worked on the scale I noticed he was
able to give lots of details of how he would know when he was
moving up. He very clearly had a step by step view of what he
would be doing as he moved towards his goal or preferred
future. I was then able to highlight these strengths to him.
Helping him to see that he was able to plan in detail and have an
accurate picture of what he wanted was a great resource for pos-
itive change in therapy, and it continued successfully.
Acknowledge feelings
Using brief therapy scales helps to set goals and keep client and
therapist forward thinking. Although I do not dwell on past expe-
riences, I do not ignore memories that may block future work. It
is important to acknowledge feelings. If there are issues that need
addressing, using the NLP strategies to soften the impact of these
negative memories helps. While thinking about NLP, it is necessary
to put in a word of warning. These strategies are powerful and
need to be explored in a trusting and supportive environment. I
have become aware of these ideas being used in a group, without
appropriate support, and this has a very negative effect on a client.
In an appropriate supportive environment I have found this way of
working very useful in helping to neutralise past experiences and
enabling clients to recognise and hold onto positive experiences.
In the process of assessment I also use a general outcome scale
to have a broad view of stammering behaviours, feelings and
attitudes. Avoidance schedules are also useful and it is helpful
to look back on these to gauge success. During therapy I like to
use a range of strategies which vary according to an individuals
needs. I believe it is important to explore practical ways of deal-
ing with stammering at the same time as working to change
feelings and attitudes. Having practical to do tasks in a session
can really help, as too much talking about things can be hard for
some clients. I very often use practical relaxation, and breath
control work is also helpful, enabling clients to start to take con-
trol of the situation. I use block modification ideas including
voluntary stammering which can be a real breakthrough for
some individuals. It is important not to forget some of the older
ideas which can be very useful. I am now on a Charity commit-
tee with someone I worked with 15 years ago; he still uses soft
contacts and found this one of the most helpful strategies.
It is important not to forget the need to maintain progress. By
using techniques to manage both the covert and overt symp-
toms of stammering I hope clients become aware that they have
the necessary tools to deal with the inevitable set-backs.
Therapy goals do not include 100 per cent fluency, and creating
a positive attitude leads on to an acceptable level of fluency
control. Life events do have an impact and we need to say it is
okay to have set-backs and to return for help if needed. Past
clients will sometimes call if a reminder is needed. Recently a
client I had seen in his teens came back, after 10 years, to run
through a work presentation. After two sessions to refresh ideas
on managing his stammering he completed his presentation suc-
cessfully and kindly rang me to let me know how it had gone.
Stammering can be a chronic, ongoing disability in adults and
l
Resources
Bailey, R. (2001) NLP Counselling. Speechmark.
For information on Solution Focused Brief Therapy,
see for example www.brieftherapy.org.uk.
I hope that, in our work settings, we are able to offer support
when it is needed. Different types of therapies may well be
appropriate in different phases in a persons life.
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