speech & language therapy in practice, spring 2009

7/28/2019 Speech & Language Therapy in Practice, Spring 2009

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PLUSWinning WaysHeres one I made earliersotware solutionsgreatreader oersreviewsand introducing In Brie

.chma.comDeveloping patience

ISSN 1368

Changing you, changing meVdo tacto udac

User involvementAdvocat ath

Oropharyngeal dysphagia

Th ach o tchqu

Oral motor exercisesA lot o hot a?

Adductor spasmodic dysphoniaTh Hou Blv Botox

Spring 2009

How I put learning into practiceBlual ht

Our Top ResourcesHad ad ck


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readeoffes

Members areaFo a md o you u am adaod, -mal [email protected].

www.speechmag.com/Members/

new! Oly ol atcl addd o s 09!I at rst you dont succeed Part 2: Toolso the tradei at 1 .12, Lz Ackoyd ctd o hmaamt o Davd 46 ho ha chocoohayal dyhaa ollo balamt ad a lt mdullay act. pat 2o mo dtal about th vaou tool adocdu h td out th cou o htatmt.

Win Memory Magic!sTAss publcato ha lad Mmoy Mac, a ouc o that ad tach- to a ad dvlo cucal mmoy kll chld th laua ad la- d cult at Ky sta 1-3 / ad 4-14 ya.

sch ad laua that Ja Booth dvd th oamm th 7 MacTck ocu; ha; ou; ctu t; ma; lk; you ll to hl chld dcovho to uot th ok mmoy ad la. Th acka clud a

toducto to ok mmoy, amt matal, okht ad advc about claoom ad atal uot. A th matal o CD rOM, ad ctu a both black ad ht ad colou, u ca t out co a ad h thy a qud.

Mmoy Mac tal at 60.00 + VAT, but sTAss publcato o a coy Free to a lucky ad oSpeech & Language Therapyin Practice. Fo you chac to , -mal you am ad add th sLTp Mmoy O th ubjct l to [email protected] by25th Al 2009. Th ll ha by 1t May.Further inormation about this and a ull catalogue o STASS products is at www.stasspublications.co.uk.

Win Bambas First Comorts!A you look o a aly la toy to hl at commucato th th bab? BambaFt Comot ha b dd by to ch ad laua that o at o 6-18 moth old ba-b. A ll a omot ml baby , th t coua a ocu o ft ok od.

Th toy kt uually tal at 29.99 + 3.95 &, but you ca o o to Free co couty o ThBaby s Factoy. All you hav to do -mal you am ad add th sLTp Bamba o th ubjct

l to [email protected]. You ty mut b cvd by 25th Al 2009 ad th ll botfd by 1t May.

Th aad- oduct cot o a cuddly moky calld Bamba ad fv toy ach t amotat od / coct o a baby. Yvo Buto-Mll ad Amada r dd t to abl atto xlo baby at hom thy a uabl to commt to attd cla, ad t alo b ud bylayou, uy cla, halth vto ad aly tvto tatv.

Details are at www.babysignactory.com/. Further Bambas Chatter Boxes are in development.

rad O ww had to ad o ou wt 08 u. Th CLeAr hooloy amt, couty o Cla rouc, o to Kayr. Mahl th lucky o salo Bac Vocabulay Dctoay Cla Bo. Coatulato to you both, adood luck to vyo th ou o.

Articles now reely available ol at

.chma.com/rouc/rt

Fac, H. & Lloyd, J. 2008 About a Boy,

Speech & Language Therapy in Practice

Autum, .12-14.

gavll, p. 2007 Fac valu, Speech &

Language Therapy in Practice summ,

.20-21.

Coming soon at .chma.com/

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Spring 09speechmag


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WINTER 08s e-article at www.speechmag.com/Members/E1 THE THIRD PERSON IN THE ROOMTalking Mats has had a proound impact, not just in the UK, but across the world.It has raised awareness that successul communication is everyones business.[Mary Turnbull]

Talk Mat a lo tch commucato amok dd to hl olth commucato d cult x th v. Avril Nicoll ot oa symoum hld to clbat th ft 10 ya h ak cluddJoa Muhy, Lo Camo, May Tubull, Chama godo, Alx gll,

Tacy Olv, Maa Vdtozz, pam Caod, ela wato ad Laua Coak.in FUTUre issUes: ADULT LeArning DisABiLiTYsYMBOLsgrOUp

LeArningpHOnOLOgYDOwns sYnDrOMeDYspHAgiAMOTOrneUrOne DiseAse...LeArning inTO prACTiCe.

INSIDE FRONTw Mmoy Mac ad Bamba FtComot.8 USER INVOLVEMENTAt the end o the course all the

participants could use the ramework,

but dierent levels o support wereneeded to complete a successulinterview using Talking Mats.Lois Cameron ad Sally Boadcb a jot ojct th thlocal advocacy vc o olth la dablt, hbyvc u collct ad vdback u Talk Mat.10 AAC E-MAILGill Townend k atcato a atoal AAC uvy bcoductd a at o th Dvc oDty ojct.11 HERES ONE I MADE EARLIER

Alison Roberts th to lo cotthay uto to omotdh Fdh Bad adFld o itt.12 CLINICAL DECISIONSThe severe nature o Davidsswallowing disordermay indicatethat the damage to the cranial nerveswas too severe to make a perceptiblechange in the saety or eectivenesso his swallowit is possible that thisintervention was too early or him.Liz Ackroyd udtak a toat cto o thay ov 12moth th a clt th v

oohayal dyhaa. pat1 coctat o th ovallctu ad clcal uacelctomyoahy hl at 2 at.chma.com/Mmb/dtal oth mthod ad toolud. p v od by PennyGravill.14 CRITICAL FRIENDSA at o a sch & Laua

Thay pactc v lot,Deborah Green ad Nicola Haytoncommt o About a Boy Autum08 by Hl Fac ad JoaaLlloyd.

Spring09contentss 2009ublcato dat 28 Fbuay

2009issn 1368-2105

Published by:Avl ncoll,33 Ka squaLauckkAB30 1UL

Tl/ax 01561 377415-mal:[email protected]

Design & Production:Foa rd,Foa rd Dstatba Fam,st. Cyu, MotoAu DD10 0Ds

Printing:Mao Catv,7 & 8, edo roadeatbou,

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Subscriptions andadvertising:

Tl / ax 01561 377415Avl ncoll 2009Cott o sch & La-

ua Thay pactc -ct th v o th dvdualautho ad ot caly thv o th ublh. publca-to o advtmt ot adomt o th advto oduct o vc od.Ay cotbuto may aloaa o th maaztt t.

sch & Laua Thay pactc ca b oudo eBsCOhot achdataba

15 AUDITthe collective opinion o authorscontributing to a recent clinical oruminto oral motor exercises or thetreatment o speech sound di cultiesin children suggests that this treatment

should be viewed as experimentalDeirdre Cosgrave, th th uotoJill Titterington, coduct almay audt a lauaut to cotoval uckad blo am ca movhooloy.18 IN BRIEFLynn Gri ths lauch ou cto to hoca hot, actcalda th a chld-dly vualtato o d o ch.19 winning wAYsYou can learn to say no with rmness,sweetness and genuineness. And you

can be eective without being a peoplepleaser.L coachJo Middlemiss addad coc about tmmaamt.20 THIS HOUSE BELIEVES INBOTOXSpeech and language therapistsare requently involved in the careo people with adductor spasmodicdysphonia. Should clinicians adviseand encourage these clients to receivebotulinum toxin injections?i ou o 2009, KendreaFocht ad Paula Leslie dbat both

d o th aumt ad ach acocluo bad o th avalablvdc.

22 REVIEWSChld ad aml, ahaa,laua o halth, lac, coodato, bhavou,tamm, cal d,motoal u, tudt, dmta,

ycholoy, chld book, ABA.26 HOW I PUT LEARNING INTOPRACTICE 1I ound that, i I had the opportunity tosay, to hear or to write a word or phrasein an incorrect orm, then it would seemto stick in my language system, andit took extra eort to convert it back tothe correct target.

Th bft o ol la jut o o th ht toth xc o clt thcommucato d cult that DawnLeoni ha ad om mmo wlh.

28 SOFTWARE SOLUTIONSAvril Nicoll mt th dcto opoll rhabltato sota adKatie Spear v stoy Tll 7-12.28 CORRECTIONA aoloy to A nodb adcollau o a oof o thfu th wt 2008 u.30 OUR TOP RESOURCESWe nd anatomical models simplyinvaluable or teaching and providinginormative counselling to patients andrelativesWe use the larynx model andhead and neck model daily.Eryl Evans, Jodie McCord ad

Ruth Best a calt ch adlaua that ok enTad had ad ck cac.

4 COVER STORY: POSITIVE INTERACTIONVIG leads to various positive ripple eects each time I use it. These ripplesaect the clients daily routines, opportunities or communication and otherphysical environment actors, as well as the carers relationship with othersaround themVdo itacto gudac Vig ha taomd Andrea Rucks actc,abl h to add atttudal ba o ca ta ad to b mootv h ok th adult th la dablt.Jane Young .7th by xla th advata o u Vig th at o chldth ch, laua ad commucato d.

Thanks to Andrea Ruck and SusanScotland or our cover photo o a

Video Interaction Guidance supervi-sion session by Chris Lomas,

www.chrislomasphotography.com.


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news

SPEECH & LANGUAGE THERAPY IN PRACTICE spring 20092

Th Talk To You Baby Cama ha uccdd attact a la amout o mda attto toto tud ut that th tyl o baby bu- ca cotbut to at-chld tacto adchld commucato dvlomt.

Th mot commo ad aodabl bu th UK o chld ad om 6 moth ac aayom th uh. D suza Zdyk, a Dvlo-mtal pycholot at Dud Uvty, qu-to ou cultual aumto that mall chldbft mot om look out at th oldaoud thm a, ach atdly ho that od o bab to mak ctv u o thatxc o th d old, thy d atto hl mdat ad mak o t o thm.

D Zdyk cad out to tud o th cam-a. Th ft a a obvato o 2,722 a-t-at a aco th UK. Aay-ac bu- aocatd th a ducto ako both at hal ad at a thd ad,uxctdly, at toad ac bu tc a lkly to b l.

Obv hockd by ho lttl commu-cato a o o bt at ad ba-b. O a that, Lot o ol cam at thth do, ad at lat hal talk to thm,but ot th chld! Ad o may at omobl! Aoth ad, why dot ol talk toth chld mo? Md ootut o abt o u! i otcd a umb o occao hth chld a babbl to tl, lay th amtoy, o babbl to a doll, but bcau th buya ac aay, th at a uabl to jo th o coua th tacto.

A th att o at talk obvdmay hav ctd at oalty aththa buy otato, D Zdyk udtooka cod lot xmtal tudy o 20 bab.whl hal a ml a t a aay-acbuy, th oth hal ml a t a to-ad-ac buy, th 10 tat ocodto ad 10 th oth.

Th fd ut that ot oly do buyotato uc th amout o ataltalk to th chld, but that th talk th to-ad-ac bu mo vad ad tt-. gv that th thoy o aay-ac bu

Wheels o change

to abl th chld to th old, t t-t that h moth dd ot th out toat t aad to b mo lkly to occu atoad-ac buy. Ad, althouh th ao fcat dc at ch, bothmoth ad bab had mo lauht h thbuy a toad-ac. Oly o baby vlauhd th aay-ac jouy, hl 10 ddo th toad-ac o.

Th lot tudy alo mad ttatv utoabout at t lvl b lo toad-ac bu, ad D Zdyk ay that l abuy mo olatd tha may adult al ad may b mo motoally movhd tha ood o chld dvlomt. ittly,hl moth xcd th to otatodtly, thy dd ot thk th at dd atlat tm o comot o t.

Commt om moth volvd add htto th fd that cha otato ca boul. it a tt th h ac to-ad m. Bcau i a talk to h all thtm, bcau h a look at m ad o you

act th h. wha, h h ac aay,y i talk, but ot qut a much. Bcau, youko you cat h acal movmt adyou ko h ot look at you to t d-back. ..i ddt xct that. i thouht h a o lk th toad-ac, h ould dmot o h tm ca out.

D Zdyk ho mauactu ll o okto mak toad-ac bu mo aodablad acctabl, ad that h ca u th ulto th lot tudy to coduct la-cal ach.Th ull ot at .ltacytut.o.uk/talktoyoubaby/Buy_ach.d.

People aected by Parkinsons Disease comment onaccess to services at the launch o an All PartyParliamentary Group inquiry

Parkinsons researchCommucato u ll tdat th ft pako Da socty rachCoc, th a kyot tato by nckMll backd u by val ot.

naly 200 ctt ad ach omaoud th old mt Yok novmb 2008to dcu a a o toc clud th-ay, tu mlat, hamacothay, at -habltato ad vc dlvy. nck latomtato a o a lot tudy look at thct o altd acal xo o comh-o o motoal cott o uttac.

nck oal hhlht a a attd both about vc ovo. Bataa Blom x-lad ho vc th nthlad a o-ad aoud tad calt o ach aa,ad td vdc that th mo ctv tm o habltato ad cot tha altovo. nck alo blv ch ad lauathat hould tak ot o go Kohaadd about th a ovo o vc at thallatv ta.

Th th ot th hch nck a volvdotd th fd om a uvy o olth pako da, th ca ad chad laua that. i addto to hhlht- th d o ou volvmt at th allatv

ta, t a cla that d to t btt atco ho ca uot clt th thychoocal act o th da.

Th pako Da socty uvy dhav alo b ud to om a All paty palam-tay gou quy to acc to halth ad ocalvc. Th socty ay a thd o ol daod th lat ya ot v cla omatoabout th codto. Mo tha a quat o ollv th pako had v ok to a cal-t u hlt th majoty had ot b ado ky tha clud ch ad laua.www.parkinsons.org.uk

Better CommunicationTh ovmt elad ha acctd mot o th commdatoo th 2008 Bco rv o vc o chld ad you olth ch, laua ad commucato d.

Th Acto pla Btt Commucato t out hat th ov-mt ll do o to ach o th commdato, h t llb do by ad ho t ll b valuatd. n tatv clud thth ya aotmt o a Commucato Chamo ad a Com-mucato Coucl, th a natoal Ya o sch, Laua adCommucato lad o 2011-12. Th Coucl ll clud a atad a you o tatv. Th ll alo b a ach o-amm ad u to 20 local aa athfd hch ll cod thaoat caacty o ch ad laua thay, ad ho that

caacty bt ud .23 a ll a om th dvlomt obt actc jot commo.

Th la uquvocal ay that all mmb o th matamchld okoc hould uot th dvlomt o all chldch, laua ad commucato kll .12 ad that all olok th chld hould ko ho to ok th calt, ucha ch ad laua that, to buld a ctv vomto all chld to dvlo ch, laua ad commucato kll.12. Th royal Coll o sch & Laua That chadth a th oo ad omot bt actc.

Th cotbuto o th evy Chld a Talk ad th Chld Halthpomoto oamm dcud, ad cal mto mad oovo o vc o you od ad chld ho u com-mucato ad. Aac, th Bth stamm Aocato ad i CAn

a all cv ud to dvlo uot o aml.www.dcs.gov.uk/slcnaction/


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news & COMMenT

SPEECH & LANGUAGE THERAPY IN PRACTICE spring 2009 3

Comment:

Developingpatience

wh i okd clcally at ad caot akd, Ho ca you b o att? Thmad m lauh a, althouh i hav tcad tay o, oth act o atcuch a tolac ad ty hav v comatually. pha that hyJo Middlemisssuto .19 o mtally mm to dotm utl a ady to dal th thm juta mm documt o a comut- m to ok o m? i ay ca, t hl to

ko that atc omth that ca b dvlod.A motat at o ou ol mak clt ad aml

aa o th bft o atc, a ll a co h may mly b ty to do too much too oo. Liz Ackroyd

.12 had th ootuty to ct o both hl t abouth jouy to dat th a clt ad o thouh th oco a ctcal d v.

But matc ha t ud t dov Andrea Ruck.4toad a vdo tacto aoach that o ucommucato ootut o h clt th ladablt ad th ca. Ad, hav udtak a tvcou wlh, Dawn Leoni .26 tt th chac toxc omth o th utato hch mut b ltby ou clt, a ll a th mact o hlul tat ucha ol la. Th ht ha toducd a hol dmo to h actc.

som acadmc a matt th clca ho t u oal moto actvt t o a lack o vdc thatthy do ay ood. Deirdre Cosgrave adJill Titteringtonsaudt .15 cotbut to th dbat. ea a dbatad cod both d o th aumt a at ayo dvlo ctcal thk kll a ou ho,b th Kendrea Focht ad Paula Leslie .20. Hovt alo a uul tool dvlo atc, a bcom motolat ad udtad o had o y ad o oth oto v ad uc.

it ctaly a to b att h udtad hyomth ha. Lois Cameron ad Sally Boa .8uccully tad ol th la dablt to u atv amok th th , but caul valuatohod that uth uot a dd th th ocal acto coduct a tv. Eryl Evans, Jodie McCord ad RuthBest back a alo acat that clt a ot ou bt

tach, a thy cotatly u u th th ablty to coth th uthkabl.

i am matt to ha you i B cotbuto .18. Youcould t about a thay ouc, advc you hav had,omth you hav ad, hat you h you had ko, oomth that ha chad you cto. O mayb vho you hav lad to hav a lttl atc?

Somewhere overthe RainbowTh UK-bad puva chaty Kya suv-vo ha ut out a ut call o doo,oo ad ch ad laua thayvolut to uta o o t ducatoal ad thay ct.

Volut at th rabo Ct hav okd th ov 400 chld adaml c t od 2001. it th oly uot avalabl th aa ochld th cal d ho a lv v ovty. Volut amto abl tho attd to bcom a ddt a obl.

Alx Bado, a oko o th chaty, ad, Kya suvvo cu-tly xc at facal toubl ad a dat o do-o, oo ad volut to hl u cotu to ovd th uotad o th aml th chac o a otv utu. To llutat th d-c that ch ad laua thay volut ca mak, h to to dcb ho 2008 nchola sutcl t a moth volutat th rabo Ct jut bo h qualfd a a ch ad lauathat om sh ld Uvty:

O o nchola cha a nadya, a tht ya old l ho da. Ath a o chool o aclt o da chld th aa o pu, nadyahad v b to chool o lat ay omal ma o commucatobo tat at th rabo Ct th ya bo. wh nchola a-

vd nadya had lad bac laua ad Makato, but a huyo mo. nchola ud Cud Atculato pay, 1995, tach nadya thhad cu o ach dvdual oud. soo, o th ft tm h l, nadyaa abl to oduc oud ad ad out od o that thy ud-tood by oth. nchola alo tauht th tchqu to nayda cla tachYca ho oud t huly bfcal h ok th nayda ad othchld th ch ad laua d cult.

Alx cla that, what nchola maad to achv a jut o mothat th rabo Ct ha od u a hol old o commuca-to o nayda.For more inormation on Kiya Survivors and how to volunteer or donate,visit www.kiyasurvivors.org or e-mail [email protected].

Supervision solutionsThak to all ad ho hav v th dback o th 2008 uvo by sam smo ad Cathy sak. May o you hav ud t to cto th uvo that alady avalabl, hl oth hav oud t hlulh tt u datmtal uvo.

sam ad Cathy a alo ollo u a ad qut o a atcl ocudo uvo o o ch ad laua that ho hav b actc o may ya. w ho to b you that atcl lat th ya.

Mahl, you ca ad about a soluto Focud B Thay aoachto ad tudt uvo at .oluto-.co.uk Dcmb2008 u. sch ad laua that Kd Bu xla ho th TMut Bu a cocvd ad th mact t ha o llb ad actc.

WellChild nominationsTh atoal chaty wllChld k omato o t fth aual

aad. Th o to chld ho hav ho outtad coua coth ou ll o dablty, to chld ho hav v xtaodayca to a d o bl th ou halth oblm, ad to ay halth,ducato o ocal ca ooal ho xctoally ddcatd to m-ov th lv o o o mo ck chld. Chld ho a omatdmut b ad bt 2 ad 18, ad t mut b by 20th May 2009.Nomination details at www.wellchild.org.uk.

PABA problemA ad n Zalad ak o uot h ot to t thpABA poald Advc Book o Ahaa ota uadd took th wdo Xp.Th Mdcal illutato Datmt at glao royal ifmay, hchoducd th oal CD, ha advd h that thy hav o la to do

th ok. sh ho that ouh that cotact thm thy llhav a cha o hat.

Nichola with Nadya


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COVer sTOrY: inTerACTiOn


it vy motatthat oly otv vd-

o cl a ud a aba o cto du th dback. Thotv vdo l-modll ha a lo h-toy o b ud to adcally ha bhav-ou B, 1983.

All flm a mco-aalyd ad dtd thc to th Cotact pcl fu 2a t o dctv cato hch cludatttv, look ad to o voc.wh aoat, hh od commuca-to kll uch a mak uto, o- choc ad olv oblm totha alo cooatd. Th ha th advatathat th Vig aoach ca b ud th cl-t aco th t ctum o la

dablty. i hav ud Vig th ta ad catact th clt th:

v la dablt ad autm ad /o chall bhavouv la dablty ad v vuamamtDo ydom ad a tammmodat la dablty ad halo.i hav alo ud th aoach dctly th

clt to cha th commucato kllTh clud a clt th autm, oth thocal kll dcult, o th a tammad a moth th a la dablty t-

act th h you chld.

Fu 2 Vig Cotact pcl o commucato

Changing you,

changing meAda ruck a look o a thay aoach that ould addatttudal ba o ca ta ad ally hl h to b mootv h ok th adult th la dablt. Vdoitacto gudac, oally dvlod o ok th aml,ovd taomatoal o h actc.

th aoach clud adult ychaty tam,halth vto, ducatoal ycholot, b-

havou uot tach ad ocal ok.whlt t dly ud by tho ok thchld ad aml, th aoach quallyld tl to ok th adult th ladablt.

whatv th clt ou, all Vig ac-tto hold val bac aumto commo:

pol h to commucatpol toubld tuato do at tochapol do ally ca about ach othevybody do th bt thy ca at thtmevy c a ootuty o cha

Cha alay com om th th d-vdual.A a Vdo itacto gud Vig i flm

5-10 mut o tacto bt a ca /uot ok ad a adult th la d-ablt. i th dt th matal ad tu oaoth day to v ad dcu val hotvdo cl th th ca / uot okfu 1. Th dback o tak abouta hou. Uually th atcat ath thath Vig dcd h thy at to to,but 3 - 4 cod ad dback o aally uct to ct a cha at-ttud ad / o commucato bhavou, o

to mak th ca l cofdt that thy cao ddtly u th movd com-mucato kll.

Fu 1 Vig flm ad dback

A a aduat actto thadult th la dablt fld,

my ok a havly lat o ta-dtoal advoy mthod uch at ot ad dcu commda-to th ta. i lt utatd that my c-ommdato ot ot ollod, adthat commucato ta okho ot ct ay al cha ca com-mucato bhavou. i ald a dtaoach a dd, hch ould allo mto add th udly atttud o ta.Aoth fcat momt my dvlo-mt a h a ta mmb ad a ot ihad tt a too atv, ad i dcdd iatd a mo otv al to my ok.

Hav had a u collau mto

Vdo itacto gudac Vig, i attddth Vig itatoal rach Coc Dud 2005. Vig t out to mov com-mucato ad latoh u vdo.Th aoach aad to comb vy-th that i a look o, ad i a tatlyhookd. i hav c ud Vig vaou ayto bft adult clt th a la dabl-ty ad th ca / uot ok, ad thoc cotu to uc my atttudad day-to-day clcal actc.

A. VIDEO INTERACTION GUIDANCE THEBACKGROUNDVIG emphasises that change can be achievedmore eectively and in a more empowering wayin the context o a coaching relationship, whichis collaborative rather than prescriptive, empow-ering rather than deskilling and conveys respector strengths and potential. htt://.cd-ducato.co.uk/voc/v.h Accd 22Jauay 2009

Vdo itacto gudac bad oa modl dvlod th aly 1980 by aDutch ycholot, Ha Bma. Oallyud th dyuctoal aml th nth-lad, Vig o actd dly acoth old. Th a cutly 800 accdtd

Vdo itacto gud ad 75 accdtduvo th UK. pooal u

reAD THis iF YOUAre inTeresTeD in

CHAngingUnDerLYingperCepTiOnsFOCUsing OnsTrengTHs AnDpOTenTiALUsing ViDeOAnD giVingViDeO FeeDBACK


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At aoth lvl Vig tach th acttoto v ctv dback to th ca / uotok. All ok du ta uvdby a qualfd Vig ta. Th Vig ta bmco-aalyd vdo cl o hm / hl t-act otvly th th ca / mmb o ta

to th uvo o fu 3 ad ctcollaboatvly th th uvo o u o thCotact pcl du dback. Th cluddt tatv ad cto att, hat b ad ad hat b covyd thoutod.

Bcau th Vig ocu o momt-to-momt lauabl ad uccul tacto,/h cvd by th ca to cat a otvatmoh. A ll a ovd a caold o thk o th ca, /h alo act a amodl o otv tacto. Look at th d-t acto hch may b cotbut to thctv o Vig, Vmul 2006, .8 ot

that Lambt 1992 dtf a otv ca-that latoh a o o th mot mo-tat acto that dct ucc a oamm.Fu 3 Vig uvo

B. VIDEO INTERACTION GUIDANCE WHY IFIND IT EXCITING AND REWARDINGa Carers change their perception o a cli-ents communicative competenceDu th dback o, th acttolt ad od to th atcat o

v, thouht ad l about th tuatoad vc va. n had ma, obl-t ad da o oluto aa fu 4.Fu 4 n ctv dvlo

i flmd a ca th a clt ho had a -v la dablty ad v chall- bhavou a dtal tt. itallyth ca claly ovtmatd th lvl oth clt commucato kll. sh vocdth oo that u clo oxmty ad a-o voc th th clt a babyh.sh ba xmt th otohl clo to th clt. O th cl-t otv o th vdo cl, had a vy o dalou about thma o a aoat. H c-to chad that v adult lk blly ad joy a bt o u. sh alo ba tomoto ad duc th umb o ky od

that h ud th th clt. sh ad that thcommdato my ot o mad

ct ha bohad h hadmly dad th thm.

b VIG generates positive eects in the car-ers and clients environmentByod th u tchcal act o commu-

cato, Vig lad to vaou otv l ctach tm i u t. Th l act th cltdaly out, ootut o commucatoad oth hycal vomt acto, a lla th ca latoh th oth aoudthm, clud ay o acc uot othmlv ad o th clt. such aocatdotv outcom ot tak lac btdback o, thout th d o advc.Th ca fd th o oluto to oblmad tat utt thm to actc.

wh i okd th a vually mad cl-t ad h uot ok paul ca xam-l 1, paul talkd to th oth dtal taad uadd thm to tch o th adohl th clt a doo. it oth otthat th cato o a qut acoutc vo-mt had omd at o my commda-to o th lat to ya.

c VIG establishes collaborative relationshipsi omtm u Vig th dvdual mmbo ta tuato h a ta ou haald to mlmt a commucato o-amm du to a dc atttud o b-l. Bcau Vig ocu o dvlo a col-laboatv latoh th a dvdual tammb, ho a a mo altc v o thclt commucato d, th ta mm-

b may tat to act a th clt advocat ada ood actc o to oth ta.

Ada ruck th Joh ca xaml 2, .6


8/32

mt th h to o voc. s hl adoth o vdo abld th clt to dtyho h covato at lt du co-vato, ad hth thy ttdo bod. Du to th clt autm ad oocomho ablty, i ould ot omallyhav vad o thouht t obl totat toato thay.

C. POSITIVE IMPACT ON MY PRACTICEi New perspectives appeari my ol a Vig, i am cotatly a ht. i hav com to acat ho cult om chall bhavou caooudly udm ta l-tm adbl th o oal comtc acommucato. Fo m, t ha b xtmlyad hl th ta to l mootv about thmlv, ad to -tablha mutual ad otv tut bt thm adth clt th ca.

ii My interactions with other proessionalshave changed prooundly

Aoxmatly 4 - 6 moth to th Vig ta-, i otcd o lav ooal mtho thy had o xtmly ll ad ld tovy otv outcom. i ald th a duto ctv cayov o th Cotact pc-l. wh i t to otato th othooal ad tudt, i o ly muchl o uad, covc o au myot, ad much mo o lt, bout th oth o ouc ad tthad abl thm to com u th th ooluto to oblm.



Follo a clt autm dao, oulocal La Dablty Tam cad outom commucato / autm ta ota, ho mad ucovcd that thclt had autm. i th cad out Vig tha dvdual volut mmb o ta. shckd u taht aay om th vdo thatth clt had a vbal oc dlay advd h oo about th dao. Atto Vig o, h otd that cdc- o chall bhavou had datcallyducd h h a o ht th th cl-t. sh akd m hth i could do aothcoul o Vig o th aoth ttdmmb o ta. Th to ta mmb du th o t o commucato ud-l ad had vdo cl th th to th collau. Th xt tm i vtd, ioud th ta much mo attud to th cl-t commucato.

d I can work with clients directlyi hav alo ud Vig vy uccully th cl-t thmlv. B 1983, .119 tat that,

o ol th mtal tadato, l-mod-ll ha joyd codabl ucc t vual, ath tha laua bad, ad th llmt mak t a ad coct. Vdoalo adly abl clt th a la d-ablty to atdly v th o adatvbhavou. Bcau all flm do a at-ual cotxt, at th clt Day Ct, at homo out th commuty, u Vig th clto xct ootut to add th d-culty th alato xcd by olth la dablt Katz et al., 1983.

e Clients show a high degree o involve-ment in their own therapypobably mo tha ayth l, i hav bamazd by th ay clt hav volvd thm-lv dco about th o thay.All too ot a that dcd o thumb ad cott o thay o. wthVig, clt uually tak cotol ov ho thyat to b flmd th ad th ac o thay,ad thy may qut addtoal o.

i okd th a clt th a modatla dablty ad a v tamm catudy 2. Vig thay th th clt a amdat mov h cofdc talk to ta.w vd ad dcud b vdo cl,hch hod th clt a lau-abl ad laxd covato th a mm-b o ta. wh i akd th clt hthi could flm hm th aoth ta mmb,h tally admttd to l vy vouad a luctat to b flmd. To motho, h aoachd m, ak i could hlhm to l oud h h a talk tooth ta.

The unexpected happenswok th aoth clt th autm hocomho a at a 3 iomato Cay- wod lvl Kol & Madlov, 1982ld to xloato o th Cotact pclo u a dly voc. A votal momta h th clt ad om c-to. O otc h dly voc o vdoatd layback, ad o th otho acto, h ad, llmayb thata ood th! ad ba to actvly x-

Case example 1: Vicky and Paul

Vicky is a woman with Downs syndrome, a severe learning disabilityand severe visual impairment. She was at the pre-intentional / earlyintentional stage o communication development and presented withseveral challenging and sel-stimulatory behaviours.

I was rst approached by Paul, Vickys new 1:1 support worker atthe clients residential home, as he elt unsure how to communicatewith Vicky. I carried out our lming and eedback sessions over a ourmonth period. At the beginning, Paul described communication withVicky as hard work. He elt he would never be able to have a longerconversation with her.

During the rst eedback session, Paul became aware o the ContactPrinciple o using a riendly voice. He had been a ootball coach and

used the terminology o cheering Vicky on, which I reinorced. Paulsubsequently experimented with his tone o voice between lmingsessions and reported back on his success: Im so thrilled I now eelthat Vicky knows who I am!

The nal lm was done whilst Vicky and Paul were in a busy ca.Normally Vicky did not tolerate such noisy environments and wouldstart screaming. However, on this occasion, she calmly engaged invocal and tactile turn-taking behaviours with Paul or 10 minutes. Paulnoted that Vickys communication was now much more directed athim. The video revealed how, or the rst time, Vicky touched Pauls armto gain his attention, as opposed to throwing objects or stripping o herclothes. Other sta also noticed a change in Vicky and reported that herchallenging behaviours had decreased.

Case example 2: John and George

John is 25. He has Downs syndrome, a moderate learning disabilityand a severe stammer. John requently isolated himsel at his DayCentre. He only engaged with his key worker and tended not tospeak to other sta or join in with any groups. His brother reportedthat, at home, John did not usually talk to visitors and would otendisappear to his room.

I lmed John interacting with George, a less amiliar sta memberrom the Day Centre. First, I did VIG with George. Following one lmand eedback, George reported how John had talked to him in thecorridor, asking him how he was. Another breakthrough was whenJohn joined in with Georges Art Group. George had set up a table atthe back o the art room especially or John and came over to speak

to him at regular intervals.I then carried out some VIG therapy with John himsel. To my

surprise, John soon started talking about his thoughts and eelingsabout having a learning disability. To him it meant he was rubbishat talking. I showed John several video clips highlighting laughterand him eeling relaxed during conversations. No severe stammeringepisodes were shown. The VIG therapy gave John a real sense thatboth he and George had un and enjoyed talking to each other.

Towards the end o therapy John thought dierently about hislearning disability: My learning disability is alright. Talking toGeorge is un! Ater three lming and eedback sessions, there weresigns that Johns communication behaviours started to change andthat these changes were carried over into dierent environments.Sta noticed that he spoke to other sta members at the Day Centre

more oten. At home, John began to socialise more with visitors.


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ReerencesB, s.J. 1983 Fdoad ad l-modl-l, Dock, p.w. & B, s.J. d. UsingVideo in the Behavioural Sciences. Lodo: w-ly, .109-126.Kol & Madlov 1982 The DerbyshireLanguage Scheme. Matlock: Dbyh Couty Coucl.Katz, p.J., MacDu, g.s., wadtom, O. & McClaaha, L.e. 1983 U vdo th dvlom-tally dabld la, Dock, p.w. & B, s.J. d. Using Video in the Behavioural Sciences.Lodo: wly, .256-266.Vmul, H. 2006 Vdo-itacto gudac pdaocal Famly ad Chld suot po-am VHT rlato to ectv ad potv Bhavou Cha, Video Interaction Guid-ance: International Research Network Conerence. Uvty o Dud, 19 May.

Recommended readingHodko, p. 1998 Commucato ALD hat do ca thk?, Speech & Language Therapyin Practice s, .4-7.Kdy, H. & skd, H. 2006 Vdo itacto gudac: A bd to btt tacto o d-vdual th commucato mamt, Kdy, H. d. VIG Handbook. Dud: Uvty

o Dud, .1-19.ncoll, A. 2005 sak klully, Speech & Language Therapy in Practice Autum, .18-19.

th oth Vig actto ad thouh u-v oth ta actto. My cu-t uv a a halth vto ad a com-muty la dablty u collau.

i ould lk to Vig ud mo dly bycollau my o multdclay tamad ultmatly aco th vc a a hol.i am alo ttd ach o th c-tv o u Vig th adult th ladablt. i l i am jut at th b oth oc o xlo Vig d a oalcato, ad look oad to u t may catv ay, o xaml th cltth dmta ad th ca.

Fo tho ho h to fd out mo aboutVig ad / o ta to b a Vig actto, vtth VeroC bt, htt://.cdducato.co.uk/voc, o la cotact m.

Andrea Ruck is a specialist speech and languagetherapist in Edinburgh with NHS Lothian, [email protected].

Acknowledgements

My cal thak to sada Motomy, edu-catoal pycholot ad Vig UK uvo, tomy ch ad laua thay collausobha Mack ad Tacy pato ad to Aedmoto, Had o sch ad LauaThay, o th couamt ad uot t th atcl. Thak alo to Joh o a- to m ha h toy ad to sua scotlado h ht du uvo o. SLTP


reFLeCTiOnsDO i reCOgnise THAT FACiLiTATing sMALLCHAnges in ATTiTUDes AnD BeHAViOUrCAn Be enOUgH TO sTArT A rippLe

eFFeCT?DO i AppreCiATe THAT THe reLATiOnsHipi HAVe wiTH sUppOrT sTAFF AnDCArers is One OF THe MOsT iMpOrTAnTpreDiCTOrs OF THerApY sUCCess?DO i BeLieVe THAT eVerYOne CAresABOUT OTHers, DOes THeir BesT AT THeTiMe AnD HAs THe pOTenTiAL TO CHAngeTHeMseLVes wiTH THe rigHT sUppOrT?

iii My observation and reporting skills haveshited towards the positivewh i obv ta o, i fd myl ocu- o th otv, hov mall. i o loay to tudt o collau that cta tammb a oo commucato. i alo olo oly ok th ta ho a ood com-mucato bcau i cay a to covctothat vybody ca commucat ll, vth ht uot. i o adot much mootv laua my ot, hhlhttth o both ta ad clt.

D. LIMITATIONS WHEN USING VIG WITHADULTS WITH LEARNING DISABILITIESwh th vdo om at o th clttatmt, i d to u that i ollo co-t ocdu a outld th Adult thicaacty scotlad 2000 Act. Flm clt ou hom o oth ou tuato caalo b tcky, a t motat to k vy-o cot o to th flm. At a actcallvl th ma that th camcod ha to btchd o ach tm a clt ho ha ot co-

td, o caabl o v cot, alkto th vdo. Th a alo val dabackto u old-ahod VCr qumt o tlv-o th vdo layback ad mot cotol:

Hav to ly o clt VCr cod hmot houhold o lo hav thm, ad/ o cay aoud bulky qumtClt may t coud by flm -d o a VCr cod ad th may ladto l ct dback osom clt th autm atly bftom v th vdo cl lo moto;th ot obl th VCr qumt.i my xc, a lato comut ad a d-

tal camcod a tal c o qumthch ca ovcom may o th oblm.

E. FAST FORWARDA a ctly qualfd Vig uvo, i mathuatc about th aoach. i cotu tola about t thouh tok mt

Respector what isworkingLike Andrea Ruck in Changing

you, changing me, Jane Young

rates Video Interaction Guidance

highly. Here she explains briefy the

advantages o its use with parents

o children with speech, language

and communication needs.

i hav had th cal ootuty o aoou ad lvly multdclay ta th u o Vdo itacto gudac Vig,a ay o v, th clt, vdo cl ouccul commucato.Vdo itacto gudac vy much hamoy th Ha. Bad o th mthat th ky to utu dvlomt thqualty o tacto, t cat a hhtdaa o th vbal ad o vbalcommucato kll hch omot otvtacto. it ov to b a dyamcay to uot cha, a t ha a dct o bac commucato ad vudtmat t valu.My u o t at t th at o chldth ch, laua ad commucato

dcult. w look at lctd cl o a flmo th tacto th th chld. Bad oth Cotact pcl o Vig, i ha hat ihav ad dcov hat thy hav to cat a mutual udtad o hat ok. it amaz th dc olylook at hat ha o ll ca do to buldcofdc ad b a damatc ca th at o to th chld tatv.it ha tthd my bl that ol atto commucat ll ad that ol toublat to cha. ev th mot uomtuato th alay omth - hovt - hch ha a otv ay

bt th at ad th chld.rv mt ca ot b tmdato dt xc o at. i amo coua thm to ho th vdocl at uch mt a a ay o dvlocofdc - ad omtm ddc- ad to uta cha by a thm aqual at th oc.

Jane Young is a speech and language therapist inearly years with Community Childrens Services,Newcastle upon Tyne.

ResourcesHa, .ha.o

Vdo itacto gudac, .cdducato.co.uk/voc/.

what thay tool hav chad youa ll a you clt? Lt u ko vath s 09 oum at htt://mmb.chma.com/oum/.



10/32

User inVOLVeMenT (4)


ood vbal commu-cato kll. Thltacy kll vad;om had ood ad-

kll ad omhad o o vy lmtd ltacy. Attdac axmlay ov th x o - oly to o-l md a total o th o thouh ll-. All th atcat layd a actv adthuatc at th ta.

w cutomd th ta u th c-l o accbl omato seAT, 2007. s-o oamm ad hadout all had mllaua, bullt ot ad ky ctu fu1. w av thouht to both th amout o -omato ad th ctoal uot qud toad ad uot udtad. w tuctudo o that th omat a amla but

ach o cotad omth that adt, ad u. w hod th ouldtmulat covato ad ad mmoy adtto o coct. w av codatoto th ay omato a dlvd ad udam ad vual f to tach abtactcoct, o xaml:

A

dvocacy to Acto ovd a ao ddt advocacy vc tool th la dablt Falkk ad Clackmaah. it am

to hl, uot, ad omot th la oadult th a la dablty by abl thmto mak dco ad hav th voc had.

Th advocacy ou atd to volv o-l th a la dablty collct adv dback to th advocacy ok.Thy had cod that th xt mth-od o a dback om vc u va aqutoa a accbl o may o thu, ad that th qualty o th omatoad a ot alay hlul o movvc. Advocacy to Acto tho a-oachd th AAC rach Ut at th U-vty o stl to a tool could b d-

vlod hch ould allo mo ol tha la dablty to v th v aboutadvocacy vc. w a atul to stlUvty rach ad et sUre houdd ou ubqut jot ojct thouh aeuoa roal Dvlomt Fud ad toClackmaah Coucl ad Falkk Couclo ud th tavl o th atcat.

w ba by hold a cou o olth la dablt to:

Tach thm to u th Talk Mat am-ok a a mthod o tv olivolv thm lct th mot ao-at ymbol o that Talk Mat could bud to hl ol v dback aboutth xc o u advocacy vc.

Talk Mat a lo tch commucatoamok volv a txtud doomat adt o ymbol. it a dal o th ojct at dd to hl ol th commu-cato dcult ct o th xcad x th v.

Th cou a u by to ta ad com-d o x o lat to ad hal houach. Th a a th k bak at ththd o to accommodat th Chtmaholday. Th ta a lad o 8 o-l but, a 10 ol om th advocacy ouhd to com, accommodatd thm all.

Th atcat had all volutd to a-tcat. Thy all had a la dablty ad

1.

2.

w tauht th coct o o ad clodquto u o ad clod box thd amout o Chtma dcoatod to t ov th da that you a muchmo omato om a o quto thaa clod o.w adatd th am o Famly Fotu toabl atcat to b to thk about thoto thy ould clud a Talk Mat. ith ft o at Chtma, akd oummb to thk about hch ymbol thymht u to fd out omo v aboutChtma. po to th o, had mad a

lt o obl oto hch motatto u uch a Chtma d, t, TVw akd ou mmb to com u thth o uto to thy matchd.U th Famly Fotu omat mad tho u ad alo hld th ou to that dt th a motat to dtol ad that th o ht o oa. it alo hld to oc th mo-tac o hav blak avalabl o ol cacom u th th o oto.

Thouhout th cou, th a ltyo tm o tto ad ov la. eacho ba th a ca o th vouk la. A th cou od, thatcat bcam mo cofdt abouttak oblty o th o laad, by th d, o atcat took chao th ca o.

Recap session

.

.

Lois Cameron ad Sally Boa dcb a jot ojct th th localadvocacy vc o ol th la dablt, hch ablvc u to collct ad v uul dback to advocacy ok uth lo tch commucato amok Talk Mat.

Advocating partnershipOUr series AiMs TOsHOw THAT UserinVOLVeMenT CAn Be

TrAnsFOrMATiOnALFOr CLienTs,THerApisTs AnDserViCespUT inTO prACTiCeAT MAnY DiFFerenTLeVeLsA pOwerFUL TOOLFOr inFLUenCingCOMMissiOners

U volvmt hat you xc? Ltu ko at th s 09 oum, htt://mmb.chma.com/oum/.

l- sally Boa ad Lo Camo

Fu 1 Accbl o oamm


11/32

User inVOLVeMenT (4)


Actv laTh atcat actv la, aklot o quto ad mak may commt.Thy vy uotv ad coua toach oth a th ollo dalou ho:

The one thing I orgot is how to ask openquestions. (Debbie)

No, I didnt think so, you did a good job lastweek. (Julian)I seen you, and you were condent. (Mary)

A a ou, th atcat xtmlyklld ad tv about v ach othdback. Th xc o cv commu-cato dback aad to b to thmad thy dd to b aud o thy ddot ovlay ay atv commt. Cata atmoh hch t a alht to makmtak ad la om thm a motat.

Giving each other eedback

w athd atcat v about thta o a oo ba ad coddth quot ud th atcl vbatm a thta a cad out. All th atcatmd to t a lot om th ta. itallyval md vou ad uu, but thdmhd ov th ft o ad thcofdc aad to buld k o k.

Th atcat acatd th cutom-d o oamm ad hadout:I I did not have the notes I would orget; mymemory is like a sieve. (John)Th atcat acatd th ay -omato a dlvd: I like the way youexplain it you make it easy, its not double

dutch. (Julian)Th atcat lt thy had chad addvlod: I think we have all improved.(Michael)Th atcat otd act adu Talk Mat outd th o: Iwas showing how to do Talking Mats withJim. He thought it was brilliant and I showedhim all about it. (Angela)We have some workers down at our projectsand they dont understand what TalkingMats is all about and we do. (Stuart)

Th commt ctd th o o l-tm ad l o achv-

mt that dvlod amo atcat ath cou od.

a

b

c

d

e)

At th d o th cou all th atcatcould u th amok, but dt lvlo uot dd to comlt a uc-cul tv u Talk Mat:

Fou o th ou could comlt a t-v ddtly ad thout omt, -mmb th fv ta. each atcata v a ymbold omt ht to hlthm mmb th ta fu 2.To o th ou could comlt a t-v th om omt ad uot adth cotud actc could achv d-dt tv.

Fou ol dd uot to mmb thdvdual ta but th that uot couldcomlt a tv u Talk Mat.

ivolv olTh ou dvlod th Advocacy TalkMat, a tv tool hch ll b ud to adback o th advocacy vc. Thy d-cud ad cho th ymbol ad th talldthm thouh tv volv ol lay. Thultd om hot dcuo about thymbol hch cho om Boadmakad cl at. Fo xaml, atcat kto u that th ymbol cho o dd-

c ctd th coct o a hlcha ua ll a omo ho a abl to alk. D-cuo about o o th ymbol o commu-cato ultd th ollo commt: whyhas he got a sh bone coming out o his mouth?Th tat th motac o volv o-l th la dablty dcuo aboutymbol lcto o accbl matal.

w hav ovdd ollo-u o touot th atcat cay out all tv th ol ho hav ud thAdvocacy to Acto vc. Fu 3 axaml o a comltd Mat h omo v th v about th advocat.

H, ymbol hav b lacd o both thatv ad otv d o th mat. L-

t ha b lacd o th atv d,ut that th o dd ot l thatthy had b ully ltd to. Th oalo commtd that th cha that hadtak lac c thy had okd th thadvocat had had too loly. O thotv d, th o a abl to commtthat thy had b atfd th th advo-cacy ok commucato, tm kad ok ad that thy ould u advocacyvc aa. Th dback a vy uul

o advocacy ta tm o a moobjctv o about th vc.

w hav alo dcud a utaabl t-v ocdu th th maa o Advo-cacy to Acto to abl th to cotuh th ojct fhd.

Th hav b fv cla outcom to thojct:

A ta cou utabl o ol thla dablt ha b ddad ud.T ol comltd th cou ad -cvd ctfcat o achvmt. Tha codabl commtmt to th

cou by all atcat ad vdc ofcat oal dvlomt.A cutomd tv chdul ad ym-bol t hav b dd o u by Ad-vocacy to Acto.Th chdul ad ymbol ll b ud tov dback ad cotbut to th qual-ty auac o th Advocacy to Actovc.Dcuo ll tak lac about u o thkll dvlod th ou th advoca-cy ad local oaato thouh Falkkad Clackmaah Coucl ad nHsFoth Vally.

w cofdt that at lat ou o th

atcat ould b abl to u Talk Matddtly to tv ol about thxc o u advocacy vc. Ho-v, a umb o u hav a hl hav b uot atcat to cay outth ft tv, hch ll b motat toot h la utu tatv:

pol qu uot th may o th ocalact o tat ad fh a tv.gtt thouh th doo ad tat to-ducto volv a umb o kll that outv d hl th.pol ho u Advocacy to Acto hava a o la dablt. not all o-

l ll b abl to u Talk Mat, o -omato about ottal tv

1.

2.

3.

4.

5.

Figure 3 Completed Mat

Fu 2 pomt ht


12/32SPEECH & LANGUAGE THERAPY IN PRACTICE spring 200910

User inVOLVeMenT (4) / AAC

dd ahad o tm. w hav dvloda o oma hch ll ovd omatoabout ol comho lvl a lla vo, ha ad hycal ablt.Codato d to b v to matchtv th th ht tv. Thll b do o a ca by ca ba thouhdcuo th ol ho ko th cltll.Fo tho ho a ot cofdt a tv-, a look o ojct to abl thmto ok a o that thy ca cotu tomata ad dvlo th kll.Ovall, th ojct ha b uccul

tm o dvlo a tv chdulad ymbol t o u Talk Mat to fdout ol v o advocacy vc. Thoc o tach ol th a ladablty to u Talk Mat a a ch x-c o all volvd ad ultd cadcofdc o all atcat:

This group is great cause everybody getsinvolved. (Julian)

It just shows what a lot o inormation youcan get rom such a small thing. (John)

I was really scared at rst. I nearly did notcome the rst time but I have enjoyed it and Ican do Talking Mats now. (Corrine)

Sally Boa and Lois Cameron are speech and lan-guage therapists at the AAC Research Unit, Uni-versity o Stirling and NHS Forth Valley, [email protected].

AckoldmtOu thak o to Ala, Co, Dbb, edd,Joh, Jula, Mchal, ro ad stuat, ho tookat th ta cou, o th thuamad commtmt. All hotoah ad quota ud th mo om th atcat.

rcseAT La Dablt Maad Ca ntokMak th cla gou 2007 gudac omak tt omato a to udtad.edbuh: nHs scotlad. Avalabl at: htt://.ldmc.cot.h.uk/accbl_comm.htm Accd 20 Jauay 2009.

roucBoadmak - .may-joho.com/Talk Mat .talkmat.com

SLTP

reFLeCTiOnsDO i inVOLVe CLienTs in seLeCTing THeCOnTenT OF ACCessiBLe MATeriALs?DO i CreATe An ATMOspHere wHerepeOpLe FeeL COMFOrTABLe wiTHMAKing MisTAKes AnD LeArningFrOM THeM?DO i ensUre TrAining HAs sUFFiCienTeLeMenTs OF FUn, FAMiLiAriTY AnD

new iDeAs?

E-MAIL O HE EDIOR

COMMUniCATiOn AiDs reseArCH:Call o atcato

H Avl,i ould lk to vt ch ad laua that to atcat a atoaluvy b coductd a at o th Dvc o Dty D4D ojct.

D4D o o to lot Halthca Tcholoy Co-oatv eladudd by th Datmt o Halth. Th D4D-HTC a collaboato btclca, att, acadma ad duty. it add u o dty adddc thouh t ocu o th d, dvlomt ad valuatoo mdcal dvc to mov halthca qualty ad ll-b o attth lo-tm codto. O o th th thm dtfd D4D that oatv tcholoy. O atcula lvac o ch ad laua that th Altatv ad Aumtatv Commucato AAC ojct th ththm.

Th AAC ojct b ld by myl ad smo Jud, so Clcalsctt th Baly Atv Tcholoy Tam. w ll b xlo u,

ca ad ooal cto o commucato ad d. w am todty aa o movmt, utu ach ad dvlomt th do commucato ad.

w a cutly cut atcat o th uvy:ch ad laua that th xc o ok th clt hou add commucatoclt ho u ay om o add commucato hh tch, lo tch, vo tch, o ho hav do o th at, adth ca.

Clt ca b o ay a, mdcal dao, laua lvl ad hycal ablty.Ou oly cluo cta a that thy hav a oo about voc oututcommucato ad otv ad atv v lcomd ad a abl tocomlt a qutoa th o thout uot om a ca.

wh ou uvy comlt am to dmat th fd thouha umb o ch ad laua thay / AAC chal ad to ha thomato th commucato ad mauactu.

i ay ad ould lk to ko mo about D4D o a ttd atcat th uvy, th by comlt a qutoa o by dtbutqutoa to clt ad ca, you ca do o o th ollo:

o to htt://.dvcodty.o.uk/aac to doload th qutoaat 1t Al 2009mal you qut ad you cotact dtal to [email protected] 01226 432159 to ak o uth omato o to qut co o thqutoa. stamd addd tu vlo ll b ovdd th thqutoa.

Th qutoa ll b avalabl a txt, la t ad ymbold cy

pCs o rbu h qut thm.

Thak you,gll Todrach sch ad Laua That, shld pCT-mal [email protected]

1.

2.

3.


13/32

Heres one I made earlier...

Fld o ttA practical way o registering the interests andhobbies o clients in a college or school, so thatthey can meet others with similar ideas andpotentially orm new riendships. The clientsnames should be put on the register i theyare happy to let people know that they have agenuine interest in an area already listed, or ithey would like to start a new one. They shouldbe prepared to accept that they might be uniquein their interest. The clients will also learn the

meaning o the expression eld o interest. Itis nice i the elds can be wall mounted but, ithis is not possible, they could be in a notebookor le.

MATeriALsTh lat ot-t ot you ca t, o youhav a otc boad o all ac you ca o blu-tac oday a u th dalcolou you ca t t, a t mo fld-lkA ht o -chat a to attach th fld to,ad hadd th th ttl Fld o itt ojut Ou itt you i hav alo oud a latc ocktd all hao dlay otcad obtaabl omHabtat mo xv, but at ad a tomov - you jut buy blak otcad to ut thockt.

in prACTiCe1. Ak clt about th tt, ad tat a o th lt, had ach ot-t ot th tham o th tt, acato, o hobby. Thcould b ayth om baktball to cooky,o a atcula bad o muc. i you a okth ol o th Autm sctum b ado om uuual tt uch a doal kfm, ta tmtabl o a od o collctlctcal lu.

2. ecoua th xt ou o clt to dtm thk about th fld o tt ht,ad lt thm add th am o tat fld.3. Oc you hav a a o mo o ol tha had tt you may fd that thy aladyko ach oth but had ot dcovd th mlatt. Hov, thy may d to b toducdo th ft tm.4. it ll b u to th clt to dcd ho toocd, o xaml hth thy ould lk tohav a t toth to a lctcal ul. it mayb ouh o thm jut to ko that thy a otalo th uuual acato o, o th othhad, that o a thy a th o ad oly atk thuat.

MATeriALsnao ht cotto ta th aot you ca fdThck ot ool may colou

rd ad black bo o colou to utscost

prepArATiOna Th clt d to choo th ou avout colou o ool ad cut olth o about 50 cm. Thy alo d th am lth o cotto ta.b O th ta thy t th o am d bo ad th oth oummb am black. Thy ll d to at th t val tmto fll th hol lth. Th uo vo at th oc o th othd o th ta, bcau a th bad mad th ta ll td to old otl, atly hd om o th t.c no thy a th ta ad cho ool to aoth o th ou th th bt about tut th ottal d.

in prACTiCe1. Th bad omd by lat. U th ta a o o th th comotad to a o ool lth o th oth at. A loo dd at o do th bad to om o hal o th at h th bad o, o tth at th b, ok om t thouh th loo, ad u th toattach that d to th back o a cha to mak th lat oc much a.plat th th comot toth, to hot o th d. som o thclt, cally th boy, may hav o da o ho to lat, ad dyaxcclt may fd t qut dcult. My advc to lt thm do t thmlv,tak th tm ov t, ad v a lttl hl h ad th. Th fhdatcl mut look ood, oth th ot about tut oth ll blot, o hl out you a ottal aho dat om. i thy fdth lat ally too dcult, aoth mthod ould b to tt th lthtoth thtly, o that thy ll doubl back o thmlv ad hold h

th lth a oldd hal.2. Ut th t at th d o th bad to t om th cha, ad mauaoud th a t. Mak a kot at th d o th t maumt,ad aoth o at th d o th hol th, lav a at th d.3. You hould o hav th ollo omato o ach bad: - a loo - a kot- a lth o lat o tt to ft oud th t - aoth kot - a lth oool ad ta - aoth kot - ad a .4. no th bad v back to th o ho cho th colou adot th am d o th ta. You may lk to u th ootuty tocoua th clt to act th t ad cv kll, mayblhtly xaat th thak you, ad add comlmt.5. To a th bad you uh th ad lth thouh th loo,ad t o tly, u a kot that ca aly b udo. each clt o haa oald bad, th th am o all ou mmb o t, o thy ll

fd t a to mmb vyo am.

Alison Roberts has two low cost, fexible therapy suggestions topromote riendship.

Fdh BadThis is a good way to bond and promote trust between a group o childrenor teenagers. They will be proud o the nished, personalised article, whichthey are making as a git to another group member, so the social skillso giving and receiving are also practised. Girls are really keen on theseitems, but boys are ne with them too. This method is an adaptation o thecomplex knotted variety.

Heres One i MADe eArLier



14/32

CLiniCAL DeCisiOns


Liz Ackroydudtak a to at cto o th vaty o tool adtchqu ud ov 12 moth th a clt th voohayal dyhaa, ad cod hy thy mayo may ot hav cotbutd to hat o ft ht vylmtd o.

I at rst you dont

succeedPart 1: When traditional techniques are not enoughreAD THis iF YOUAre inTeresTeDininTerVenTiOnsTHAT Are nOTsUCCessFULBiOFeeDBACKTeCHniQUesA HYpOTHesis-

LeD ApprOACH

Tadtoally my ol th maamto dyhaa o ou habltatout ha b a vy amla o:a; dao; alt txtu ad,

aoat, ty comatoy tchqu.Th atcl dcb th jouy a clt thv oohayal dyhaa ad i tookh tadtoal tvto dd ot ok. ia vy aa that th latvly you maad h amly acd th a dvatattuato. Ov th may moth o myvolvmt, i ud a vaty o mthod ad

tool to ty to at. whl th a xlad mo dtal at 2 o th atcl at .chma.com/Mmb/, i ll coctath o th clcal ctu.

DavdMy clt hom ll call Davd - a 46 yaold mal. H td to h gp th a ol-l tou ad chok o h ood Jauay2007. H ubqutly dtoatd ad adaod th bala mt ad a ltmdullay act. H alo ud a cadacat ad a th tubatd ad tacho-tomd o 28 Jauay 2007. H a d-ca-ulatd May 2007. A enT v at thtm vald ood vocal cod moblty blat-ally, mmal hyohayal cto, ad aomal layx th ducd layal ad ha-yal ato o th lt.

Davd cvd ula ch ad lauathay hlt th acut hotal. ic adcomato talld but h allomad ua o oal tak.

i Ju 2007, Davd a tad to thuolocal habltato ut. wh i fta hm, clcal tato cludd:

dama to caal v Vii, iX, X, Xi, Xiidyatha dyhoa altto voc

oo l aladquat aohayal clou

o layal o hyod movmtdu hayxoo ato uaa o bolu hayxctv couhoo cto maamt qutlyxctoat to a tult dd acal aly suybook Facalgad sytm ro et al., 1996 co4/100 u lmb ataxalo o atooo oocto

adadochok moto coodato a-ocatd th cblla damaoo f moto cotol h had.Th cblla mo aat

blo th had ad ck. Davd tdth a dyatha but th a ot a ataxcty. Th ovd atu a h hh-tchd, tad / tald voc. H cha hhly utllbl xct to vy aml-a lt.

Hyoth-ldi admtd th Jay Obvatoal A-mt o Dyhaa Adult Hbbd & Taylo,2005 o admo. Th ud th clcathouh th oc om al to utdtatmt. Th cto clud ca htoytak, oo-moto ablt ad clcal alloamt. it allo th clca to tak a hy-oth-ld aoach to th amt adtatmt o dyhaa.

Th hyoth i omulatd :poo l al vtd th u b- matad to allo ato-otota o th bolu cohvly.rducd at, a, tth ad co-o-dato o th tou mucl ultd oo oal cotol o th bolu.

Th uahyod mucl obl ohyod xcuo ad lvato ak.

1.

2.

3.

Th lack o hyod movmt atvlymactd o th ablty o th layx to l-vat ad xcu.poo oy dback om th l adchk, oal cavty ad hayx ultd oo aa o th bolu ad th ult- blut ovdd by th mdulla actv.

Davd had a d lo moto uolt dd acal aly th ma ov-actvtyo th ht. Th acal aly had a fcatmact o th tllblty o h ch ad

h ablty to achv l al. A Tohc elc-tcal stmulato am to vt o vcha aocatd th mucl atohy, ud a nuo4 tohc lctcal tmulatotc daly th Davd o hou block. ialo toducd a vaty o tool ad -tv xc to ty to mov tou mov-mt ad coua btt l al, ad tda umb o comatoy tat.

potv ctTh Tohc elctcal stmulato Tes ad u-mou oo-moto xc talld th Davdhad a otv ct o th ymmty o hac at t, th mot otabl dc ba ducto th ov-actvty o th ht do h ac.

A thautc tool FacFom; acal-x couad Davd to ly too havlyo h to d to om th actvtqud, thy dcotud. Th ov-actvty o o d thout tat actvtyo th oth could dcat that th mucltatd ot a adquat codtoto od to th actv xc ad tho toducd too oo. Davd ho-v lad th th movmt h a-cal muculatu ad cotu to u th Testh a v to toduc tl xc

h th codto o h muculatu hamovd uctly.

4.

5.


15/32

CLiniCAL DeCisiOns


i ud th suybook Facal gad y-tm to ovd a bal ad ula out-com mau o th u o Tes ad oo-mo-to xc. Th ytm ovd a comotco o acal ymmty thouh a calculatohch tak to accout th ymmty ovolutay movmt, t ymmty adyk o ach movmt d o -volutay cotacto a a ult o th val to tch o. A comot co o100 dcat omal acal ymmty.

Davd ovall co cad adually om4/100 to 30/100 25 July 31 Dcmb 2007.A th oth at o a damad v a-oxmatly 1mm a day, th tho aato b a xcllt outcom. Th movdymmty du to ducto ov-actvty hada hu mact o h aaac at t. Thmot otabl cha actv movmt aclou o h yld ath tha movmt ol. Th a lmtd cha th co oth oth mucl tatd. Th cko movmt o th oou o th codt o maumt ad du oth -

o but th ot o th occaoth ad ytm a ud. w ud hoto-ah to mau cacy.

Th combato o Tes ad oo-moto x-c a th mot lkly xlaato oth makd movmt Davd l alollo thay. But, hl l al a ouctoal o allo, th a o mov-mt Davd dyhaa, ad th tvtou xc had had o mact o lva-to ad xcuo o th layx.

pobltyi udtook a ltatu v to hat oth- tchqu mht b utld, ad th adth oblty o th mucl bodback toolcalld uac lctomyoahy eMg.

Clcal uac elctomyoahy eMgbodback ha b xtvly utld oth alm o hycal habltato adha ov clcal cacy o a vaty o d-od Huckab & pllt, 2003. i ctya tt th alcato o eMg dyhaa habltato ha cad mak-dly. U t du allo ca ot olyovd omato o th tm ad la-tv amltud o lctd mucl cotactoatt du allo, but t alo o-vav, labl, latvly xv adaly lad by clca Cay et al., 2004.

it ovd al omato adth duato ad amltud o mucl actvtydu allo hch dlayd o a com-ut c ad ovd mmdat d-back to th att. it ovd tataou,omac-cott dback adth ucto o a hyolocal o ycho-hyolocal ytm. it a xto o thatt o clca Kama, 1994,.67. i th uoc oulato thmay b mad oocto ad a-to ad thu ovd vbl dback may

aumt th ytm. Th a ctaly thca th Davd.

i av Davd cfc tat hch -vd o a othtly ba to tablh thcacy o th eMg. Th ft tatmt oal:

1. To duc th lth o tm bt -toducto o th bolu ad allo tatoto 35 cod tal bal = 40 cod.i dlvd 2.5 ml o at va a y to thaa jut bhd h lo ot tth.

2. To ca th amltud o th ak omucl actvty to 75 mco volt o at lato allo ach o. Th maxmumak at bal a 50 mco volt.

3. To ca Davd lvl o atacto /joymt o allo tal. Th a ma-ud u a l-at cal, th 0% bubaabl ad 100% b vy joyabl.

4. To dca cvd lvl o tul. Al-at cal a v to Davd th 0%xtmly dcult ad 100% otl.

itato o th allo quc occudth 10 cod o th toducto o thbolu o ach allo attmt. A th m-ovmt a otd om th ft tha-

utc u o th eMg, t call to qutoth valdty o my bal mau. Follo- ou k o thautc ut o ohou daly th a o cha th lvl otul Davd cvd th ach allotal. Th lvl o atacto Davd lt avaabl thouhout th thautc odbut ad bt 40-60%.

Th o occao h th aml-tud achd 75 mco volt. Th a oca th dtal bt ttat ad th amltud du allo at-tmt. Th umb o allo talld o vad ddt o th lvl o a-

tu ad oc ad duato o couh tocla th bolu, but th ava a ou.Th clcal o aato ad / o

tato o ach o th allo tal ueMg ov th ht-k od. Th o ayacc to objctv mau o allo th thhabltato ut ad o th a o atdFees Fbotc edococ evaluato o sal-lo o vdouoocoy. Davd cotud tohav a vy oductv couh hch a movdt du allo tal. H xctoatdth bolu ad cto to a tu. H ma-amt o cto dd ot od to ay oth mdcal tvto o xaml Hyocad cotud to b a cau o at mbaa-

mt to hm. H dvlod a cht cto butth tam dd ot cod th to b aato.i lht o h cotud dcult ad lack oo dt tv tvto, cotu- th eMg a ot aoat.

UchadTh a o ctbl movmt -ctv o aty o Davd allo dtx moth o ch ad laua thaytvto.

Layal movmt mad mmal.H omac o th Jay Obvatoal

Amt o Dyhaa Adult a u-chad om admo.

Th ky to th ucc o eMg th -o a cfc bhavou to modyth uually ult ad volutay hyolo-cal oc Baoky, 1995. i a aa thatDavd a vy av du th t ha-bltato oc. Th mact o th avtyo th outcom ucla but t may atallyxla th lack o ucc.

Th a o om avalabl o amltudo eMg al. Th ltatu ut a tat-tcally fcat dc bt omaldu to th d amout o ubcutaoutu ach dvdual ha ad tho t otobl to tat hat amltud qudo a a ad ctv allo. O cto,utl amltud a a oal a a ooumau a th lacmt o lctod ota xact cc stl, 2004. Th eMg alovd omato to th clt o th -omac du that o o ad th-o ot tv to ho ctv thay hab. i Davd had b abl to u a maou-v uccully ollo th mlmtatoo eMg, th ould hav dcatd t c-

tv a a clcal tool.it a ucla hch mucl b

maud du th thay. eMg ovdto b a mc maumt o muclucto th hayx. Th o dftva th th ltatu a to hth th motat th u o eMg th cltth dyhaa, atculaly h u t aa amt tool. Hov i lt that thlack o co had a kock-o ct o myablty to t altc oal th Davd.

Th v atu o Davd allodod, uch that th a mmallayal lvato at x moth ad aa at

tlv moth at tv habltato,may dcat that th dama to th caalv a too v to mak a ctblcha th aty o ctv o hallo. Th a a umb o ot oucc th eMg ad dyhaa maymoth o ya ot-ot, ad t oblthat th tvto a too aly o hm.

Davd ad h amly otd that thy hadot b atfd th th lvl o chad laua thay ut h had cvdad dd ot l that i had td had ouh.wok o th habltato ut ca bchall du to ol hh lvl oxctato ad, h o cha occu,

t dcult o clt ad th latvto acct. Hov, i alo od th ayth l i hould hav td.

Davd ha b d o uthtvto a a outatt. Th , ayt, o cha h ablty to maa hcto o at ad dk.

Th lack o o mad th thtadtoal aoach to dyhaa thayth th clt ld m to udtak athoouh ltatu ach to fd a obloluto. Th oc o th dvlomto th qumt ad t u th th cltha b valuabl ad ha addd to my

kll ad tho o th t o th ch adlaua thay tam.


16/32

Uad qutoA la umb o quto a lt ua-d. Th lmtd vdc a to hchatcula clt ou bft om eMg th habltato o th allo ad a au-cty o omato ad tho o homt ha b uuccul. i om d o la-yal lvato ad allo quc c-ay bo commc eMg?

Th o cla otocol o th tm adqucy o u o th mthod o dyhaatatmt. it alo ucla ho quckly ultould b th tchqu a bfcalto th clt. Th ublhd ach utthat movmt a ad ad that oal takhould b commcd k o obl.A th clt ou ho d a much lood o ut to mov th allo?

w cotu to u eMg o th ut, ad avaluat uth t cacy a a thautctool o uolocal dyhaa.

Liz Ackroyd is a speech and language therapistwith South Birmingham Primary Care Trust, e-mail [email protected]. Part 2 othis article (Tools o the trade) is at www.speech-mag.com/Members/.

AckoldmtThak you to my clt o allo m to hath omato ad to my collau o thuot.

rcBaoky, i. 1995 suac elctomyoahcBodback ad th patt th Dyhaa:Clcal Ootut ad rach Quto,

Dysphagia 10, .19-21.

Cay, M.A., Caaby, g.D, goh, M.e & Hlth,M.A. 2004 Fuctoal Bft o DyhaaThay U Adjuctv eMg BodbackDysphagia 19, .160-164.Hbbd, J & Taylo, J 2005 Jays ObservationaAssessment o Dysphagia in Adults. Qut Ta- UK: .qut-ta.com.Huckab, M.L & pllt, C.A. 2003 Manage-ment o Adult Neurogenic Dysphagia. n YokThomo.Kama, g.s. 1994 suac eMg codtchqu: A m Physical Therapy ProductsVol. 54 .67.ro, B.g., Fadt, g. & ndzlk, J.M. 1996Dvlomt o a tv clcal acal ad- ytm, Otolaryngol Head Neck Surg 114.380-386.stl, C. 2004 Tat Dyhaa th eMgBodback, The ASHA Leader, .2,23. Avalablat: htt://.aha.o/about/ublcato/lad-ol/achv/2004/040720/040720d.htm Accd 19 Jauay 2009.


CLiniCAL DeCisiOns

SLTP

CriTiCAL FrienDsThis article has been considered by Penny Gravill, specialist speech and language therapist atAberdeen Royal Inrmary and The Lindens Clinic, Aberdeen. Penny says:it ha b a lau to uch ovatv ad ddcatd cto o ok. i thk hovthat Lz too had o hl a h dd a at dal. A h ay, oth o a damadv 1mm a day ad, th tm that h a cod cha, th a otcabl adchatd movmt. Th mbalac ad ov-domac o th udamad d ha tob vd a ll a th atohy o th damad d od to to th mucl tuto otmum hyolocal codto. Th tak tm; movmt ov ya ot moth may mo v ca. Oly h th ha b achvd ca movmt att bcouad. i Davd ca, t at oly a olatd v atholoy but comlx adv dama volv val v ad at o th ba tl, o a quck ult amobabl ad hat a achvd ov th moth o tatmt may ll b th tto to uth covy.

it oud a Lz had a lot o u o h om latv to t ult. Hov, md-ullay volvmt ca b lo - ad may ot cov at all. it motat that a oooo dcud th att ad latv, to ducat thm about th lo ocovy ad to u ay otv o o, hov mall, a th oudok ook o oth oal.

it alo motat to b aa that th cl o bodback caot b ulflldthout ull att atcato, o th clt avty thouhout th habltatooc m fcat. i hav clt atculaly ldly o ho caot co theMg, o t ot a uul tool o thm. it oth ot that th ach ltatu uvy cotvly abl ad motvatd att.

s gavll, p. 2007 Fac valu, Speech & Language Therapy in Practice summ, .20-21.

no avalabl at .chma.com/Mmb/.

what do you fd hlul lo-tm -habltato? Lt u ko va th s09 oum at htt://mmb.chma.com/oum/.

reFLeCTiOnsDO i HAVe A reALisTiC eXpeCTATiOn OFHOw prOgress MAY Be inFLUenCeD BYUnDerLYing pATHOLOgY?DO i COnsULT THe LiTerATUre AnDCOLLeAgUes TO DisCOVer newTreATMenT MeTHODs?DO i BeAr in MinD THAT THe TiMing OFinTerVenTiOn CAn Be As signiFiCAnTAs THe QUALiTY?

Ctcal FdlotFollowing a suggestion rom readers that

Speech & Language Therapy in Practice

should pilot a orm o supportive peer

review, two volunteers responded to arequest or a retrospective critical riends

appraisal o About a Boy by speech and

language therapist Helen Francis and

occupational therapist Joanna Lloyd.

Th atcl aad ou Autum 08 u.12-14 ad o ly avalabl at .chma.com/rouc/rt. it tllth toy o Mak Joh 14 ho had ooudad multl la dcult, oydv ad v commucatodcult. H a od a collaboatv

idvduald soy evomt iseoamm th oy tato tchqu.Th atcl xla ho th od th doo tohm ach h ottal.

Dboah g cal ch ad la-ua that th rchmod La D-ablty svc, ad ncola Hayto a chad laua that ok th youadult th la dcult o th To-thTut stockot.

Dboah commtd that th atcl a -md o th xcllt cl ad actcal-t o ise hch my xc ha xlca-bly o lhtly out o aho. sh atculalylkd th cla vdc th atcl ovdd oth ctv o co dcl ok ado hhly tuctud acto la th clalydtfd oal ad mauabl outcom. Thcluo o omato about a ll ddad clcally valuabl tool o cod obva-to a alo lcom, ad Dboah ac-atd th ootuty to ho cfc tha-utc tvto ov th lo-tm had aotv outcom o th clt al commu-catv kll. sh addd that th chall oad to fd ay o lcat th ok thy actc l tuctud vomt, olack ootut to o jot, lo-tm ut.

ncola Hayto alo oud t a atcl,

hch a tt ad lvat to h aa oactc. it a atculaly lcom a h lth o lttl tt about ad ublhd th fld. Althouh t a vy ad, t a oodto ha that ol mak a at ot to achout to ad uot th ottal o a you -o th uch ooud ad comlx laad hycal dablt. ncola had th atclth h occuatoal thay collau ho,lk h, oud t uotv o th ok thy al-ady do. Fo ncola tm hov th majolmtato o th kd o actc.

I you would like to comment on any article as parto the critical riends pilot, please contact editor

Avril Nicoll, e-mail [email protected] ormore inormation.


17/32SPEECH & LANGUAGE THERAPY IN PRACTICE spring 2009 15

AUDiT

A

ll ul attd th laua uth Dd ok hav a cfclaua dod. som o thm

alo hav a hoolocal dodth a moto comot, hch toh a hoolocal / atculato dcult.w dcdd to coduct a lmay audt ocut actc to th a a fcataocato bt movmt uckad blo ablty ad hoolocal kll th chld. Th ult v dcato oth dcto o utu ach ad dattatv cocluo o actc.

A. RATIONALEMay ch ad laua that havb tad ad u o-ch oal moto

ad atoy xc th tatmto a d a o ch oud dcult chld Lo & wato, 2008. Hov,th ha b a at dal o vocal acadmcdcuo aoud th valu o uch xco th tatmt o ch oud dcult o xaml Bo, 2005; Clak, 2003ad th cou that th lttl - ay- ood qualty ach to uot th u.Futhmo, th thotcal ud ouch a aoach o tat ch ouddcult a a om oud Clak, 2003.idd, th collctv oo o authocotbut to a ct clcal oum to oalmoto xc o th tatmt o choud dcult chld ut that thtatmt hould b vd a xmtalad, a uch, hould oly b cad out ochld th th omd cot o that / ca poll, 2008a; rucllo, 2008;Lo & wato, 2008; La & paback, 2008;poll, 2008b.

Dt th, oal moto thay th amha o uck ad blo ha b-com a oula ulmt to tatmt omay ch ad laua that thaoach to chld th ch oud d-fcult. Th ot a uuual tat o aa;Jo & p 2008 lookd at cut ac-

tc th tatmt o chld th choud oblm thouhout th UK ad

oud that clca tdd ot to b u-cd by th cut vdc-ba thchoc o thautc tvto. idd

Lo & wato 2008 oud that, out o 537ch ad laua atholot uvydaco Amca, 85 ct ud o-choal moto xc a at o th tatmtm o chld th ch oud d-fcult. A Bo 2005 mha, thloy advt, u toy ad aoatl-ot o ta th aa o oal mo-to thay o ch oud dod alycovc th ch ad laua thatto at lat ty th aoach out.

rach to th tatmt o mld to mod-at ch oud dlay ho that a ao thautc aoach do ok gut,

2001; 1998; Jo & sy, 2004. Hov, tm that a ch oud dlay bcommo v ad dodd th a otqut o tahtoad. rct achut that th htoou atu omo v ch oud oblm mathat om thay aoach may b moctv tha oth dd o th u-dly lvl o bakdo stackhou& wll, 1997; Dodd & Badod, 2000; Doddet al., 2004. A a coquc o th, buych ad laua that ot adota clctc aoach to th tatmt o thmo comlx ch oud dcult. Thtoolbox o thautc tvto ota mxtu o aoach that a both v-dc-bad uch a mmal a thayad o-vdc-bad o xaml, oalmoto thay Jo & p, 2008.

Ou audt tho look at cut actc a laua ut o chld th cfclaua dod. w vtatd th ao-cato o oth bt uck / allo/ bath ablty ad ch oud kll o aou o chld t th modathoolocal / atculato dod.

B. METHOD1 Participants

Th a ou cla th Laua Ut,ach cot o 10 chld ad vcd

by 1.3 ch ad laua thay hol-tm quvalt. w lctd chld thhoolocal / atculato dod om

may o ad to = 12, a a = 5-7 ya. Thy all had om d o dcultyth uck ad blo actvt but olyo had had vou thay volvuck ad blo xc.

2 Procedurea Assessment o phonologyTh cla tach ad th d ohoolocal mamt u x dt lvlom vy v 0 to a aoat ch5 adatd om th outcom maumtda u by edby et al. 1998 tabl 1.

Bad o Fltch 1972 cta o dadok-tc at, o o th chld abl toquc ch oud th th a axctd. Th ult dcat that all atc-at had a d o oal moto qucoblm althouh th o thm had a la-tvly mld co o th vty at cal.

b Assessment o sucking and blowingabilitiesDd mad omal -tatmtmaumt o ach chld uck adblo ablt tabl 2, .16. Thy volvd

th ollo:Lth o tm cod tak to uck.

A lot o hot air?i t o acadmc cotovy ad a lack o vdc o ctv,o-ch oal moto ad atoy xc a commoly cludd

thay oamm. Deirdre Cosgrave,th th uot oJill Titterington, coducta lmay audt a laua ut to uck ad blo am ca movhooloy chld th modathoolocal / atculato dcult.

reAD THis iF YOUwAnT TO

KnOw wHAT is

wOrKingBACK UpprACTiCe wiTHeViDenCe

prOMOTeCLiniCAL /ACADeMiCCOLLABOrATiOn

L-r Dd ad Jll

Table 1 Severity ratings orparticipants phonologicalimpairments0 = severe, 5 = age appropriate

Participant Severity Rating

A 1

B 1

C 3

D 2E 2

F 4

G 2

H 3

I 4

J 4

K 2

L 3


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u ad ta 5 cadboad ccl om olat to aoth 2 cm damt ad mm thck.Lth o tm cod tak to uck uad ta 5 Malt om o lat toaoth.Th amout o yohut ptt Flou uckdu a ta 70 cm lo ad cm dth 60 cod.Th dtac cm a dat a blo oma blo-dat 3 cm damt ad 50 cm lth.

it motat to ot that all look at thtth ad utaablty o uck hl vlook at blo / ocd xato.

c Treatment providedTatmt volvd ta ad actc o allth kll ad u a a o uck adblo actvt ad oal moto toy whtlsto Thay rouc. Dd cad outth actvt oc a day, th day a k ova x moth od th chool tt. Th amo th thay a to ca th tth ad

utaablty o uck ad blo. Accodto th atoal ovdd o th aoach, tham to ca th hyolocal / atoyuot ad omoto la adoamm cay o ch ult movd tllblty va d walt, 2006.

Addtoally, Dd vtd th at o thchld to attd a tach / advc oo th u o uck ad blo tchquo dvlo tth ad a o mov-mt oal muculatu. sh dmotatd aa o actvt u a vaty o blo toyhtl, blo-dat, ta, kazoo ad uckam. sh av a lt o th ty o toy ad

objct uul o dvlo th kll to achat ad actvly couad thm to actth actvt a ot a thy could du thk at hom. Th audt dd ot valuat th x-tt to hch th uck ad blo actvt cad out at hom, hch ould b uulto cod utu vtato.

Th chld alo all cvd a tycal dctclctc ch ad laua thay aoachtoad hoolocal tatmt hch cluddmmal a ok ad audtoy ta Jo &p, 2008. Th a ovdd th 1:1 tha-y o ad cla ou o to to th

.

.

v.

tm a k.Dd atd th am mau otd

abov both hoolocal vty at adomal uck ad blo tak at th do th thay od.

C. RESULTSstattcal comao o ma wlcoxosd rak Tt o ad ot-tatmtmau hod that th a a fcatmovmt all mau at thay,clud th vty at o th hoolocal

mamt tabl 3.Fu 1 to 4 ho th ad ot-tatmt

co o ach uck ad blo mau.Th lth o tm tak to uck th tat ocadboad ccl ad Malt ot l a chl-d ot btt at th kll, hl th dtac oyohut uckd ad th lth th dat could bblo cad.

Th ult ut that thay o thuck ad blo tak mov om-ac o th kll. Thy alo ho that vtyo hoolocal mamt dcad f-

catly th th to ot-tatmt od.it motat to k md that th chl-d all cvd a mo dct clctc aoachto th tatmt o th hoolocal d cultalod th uck / blo xc.

To th a a aocato bt ayo th uck ad blo actvt ad m-ovd hooloy, a sama cola-to bt th fv vaabl outld tabl3. A fcat aocato a oud btth vty at o hoolocal mamtad th dtac o blo th blo-dat [ =

.04], but ot o ay o th oth vaabl hchall volvd uck actvt. Th a a d- o vaablty movmt mad o thblo-dat blo tak hch ad om o m-ovmt by o chld ho had cvd th-ay o uck ad blo vouly ad hooducd a blo omac o 200 cmo both - ad ot-tt to a movmto 200 cm by to chld ho uabl toblo th blo-dat o th bal mau at all.wh -a sama colato xclud- th outl ho cod 200 cm ad ot

Table 2 Inormal pre-treatment sucking and blowing measures

Participant Sucking cardboard Sucking Maltesers secs Sucking yoghurt cms Blowing distancecircles secs cms

Pre Post Pre Post Pre Post Pre Post

A 66 14 100 29 35 30 100 125B 33 12 100 42 15 22 75 150C 31 12 100 60 18 35 0 150D 100 15 100 23 21 48 100 125E 34 18 100 100 64 55 100 175F 100 100 100 100 17 37 0 200

G 16 15 100 100 85 170 150 200H 18 10 60 100 79 100 200 200I 100 12 100 27 51 60 100 150

J 31 21 100 60 43 38 150 200K 21 12 100 60 30 37 0 175L 18 16 100 100 19 130 0 200

Note. For cardboard circle and Malteser sucking we allocated a value o 100 seconds to those children whowere unable to attempt the task.

Table 3 Comparison o means or pre and post-treatment measures p-values obtained rom WilcoxonSigned Ranks Test 2-tailed

Severity rating or Sucking Sucking Maltesers Sucking yoghurt Blowingphonological impairment cardboard circles blo-dar t

.02 .003 .03 .02 .003

p < .05

Figure 3 The amount o yoghurt sucked up a

straw within 60 seconds

Figure 1 Length o time taken to suck up and transer

5 cardboard circles

Note. A value of 100 seconds was allocated to those children who wereunable to attempt the task.

Figure 2 Length o time taken to suck up and

transer 5 Maltesers

Note. A value of 100 seconds was allocated to those children who wereunable to attempt the task.

120

100

80

60

40

20

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tatmt, a dca fcac to [ = .08]a oud. Th tll a td th am dc-to, but dcat that th aocato duth vtato th la umb ad amo homoou ou.

D. ANALYSISA a mall cal, lmay audt th a maylmtato hch mut b otd. Th a aaudt o cut actc ath tha a achtudy o th a o cotol ou. All th chl-d cv thay o hoolocal ma-mt cludd ad tho htotyo th codto a ot cotolld by cluo/ xcluo cta. Th addtoal dct hoo-local thay ovdd ll hav ucd m-ovmt hoolocal mamt.

Lmtato ot dctly aocatd th thtudy b a audt ath tha ach a thatth vy mall umb hch ducdth o o th fd, ad alo th a o-tabl vaablty omac o th omalmau ud to a uck ad bloablty. Th vaablty may hav b latd to

th atu o th omal amt ud adt ould b motat to valuat ho to ma-u th kll mo accuatly utu tud.Vaablty may alo hav b du to th hto-ou atu o th ou ad th ould alod to b cotolld o utu tud.

Dt th, th audt ha ovdd om -tt lmay fd. notably th aa fcat movmt all th mauot-tatmt. whl ko that cov-toal dct thay o hoolocal ma-mt ok, ad th may xla th dca hoolocal vty otd, th fdho a fcat aocato o at th lat

a td that dcto bt movmt blo ablty ad hoolocal kll t-t. Th claly aat uth vtatothouh a ach tudy u la umb,a mo homoou ou, mo accuatblo mau, ad cotol ou/. Thlk bt blo ad hoolocal v-ty may dcat that om chld th hoo-local mamt hav oblm th cotolo xato aocatd th th d cult.

whl k th lmtato md, t o-bl to da om ttatv cocluo o clcalactc. Th u o uck ad blo xc

to uot th dct tatmt o hoolocald cult hould b tatd th cauto. suck- xc atcula hould b coddvy caully lato to ach chld cfcd bo cooat thm to thayla. O th oth had, dvlo blokll, atcula ocu o mov th oco xhalato ad th ablty to ad ao, mayb hlul o om chld. Actvt uch ablo ootball, blo-dat ad tho that couaolod oducto o oud uch a //, /z/ o/a/ could mov atoy uot o chad obly hl chld th hoolocal m-amt mov th ablty to ad ao och oducto althouh, o cou, th valuo blo xc o mov hoolocald cult ll d to b cooboatd by coclu-v, ll-dvlod ach.

Deirdre Cosgrave is a speech and languagetherapist with Western Health and Social ServicesTrust in Derry, e-mail [email protected]. Jill Titterington is an associate lecturer in speechand language therapy at the University o Ulster,Jordanstown, e-mail [email protected].

AcknowledgementsThak to th chld, th at ad thtach om woodlad Laua Ut Dyho atcatd th audt. Thak alo o thuot o Ua idll, th sch ad LauaThay Tam Lad wt Halth adsocal Ca Tut o acltat th ojct.

Figure 4 The distance a dart was blown rom a

blo-dart

ReerencesBo, C. 2005 what th vdc o.? Oalmoto thay, Acquiring knowledge in speech,language and hearing 73, .144-147.

Clak, H.M. 2003 nuomucula tatmto ch ad allo: A tutoal, AmericanJournal o Speech-Language Pathology 124,.400-415.Dodd, B. & Badod, A. 2000 A comaoo th thay mthod o chld thdt ty o dvlomtal hoolocaldod,International Journal o CommunicationDisorders 352, .189-209.Dodd, B., Cob, s. & Holm, A. 2004 Core Vocabulary: Intervention or children with inconsistent speechdisorder. Autala: patal rach Ct.edby, p., Joh, A., sloa, M. & pthhm, B. 1998 Therapy Outcomes: Speech Language Pathology.Lodo: sula publh gou.Fltch, s.g. 1972 Tm-by-cout Maumt o Dadoktc rat,Journal o Speech and HearingResearch 15, .763-770.

gut, J.A. 2001 Comlxty phoolocal Tatmt: Clcal Facto, Language, Speech & HearingServices in Schools 324, .229-241.gut, J.A. 1998 Tatmt cacy: Fuctoal hoolocal dod chld,Journal o Speech,Language, and Hearing Research 411, .s85-s100.Jo, V. & p, T. 2008 Chld th hoolocal oblm: a uvy o clcal actc, InternationalJournal o Language & Communication Disorders432, .154-164.Jo, B. & sy, T. 2004 Th vdc ba o th tatmt o atculato ad hoolocal dod chld, rlly, s., Doula, J. & Oat, J. d. Evidence based practice in speech pathology.Lodo:whu publh, .258-285.La, n.J. & paback, M. 2008 Th alcato o vdc-bad actc to och oal mototatmt, Language, Speech & Hearing Services in Schools 392, .408-421.Lo, g.L. & wato, M.M. 2008 A atod uvy o och oal moto xc u: imlcatoo vdc-bad actc, Language, Speech & Hearing Services in Schools 392, .392-407.poll, T.w. 2008a Th u o o-ch oal moto tatmt o dvlomtal ch oud

oducto dod: itvto ad tacto, Language, Speech & Hearing Services in Schools392, .374-379.poll, T.w. 2008b A tatd valuato o och oal moto tatmt, Language, Speech &Hearing Services in Schools 392, .422-427.rucllo, D.M. 2008 noch oal moto tatmt u latd to chld th dvlomtalch oud dod, Language, Speech & Hearing Services in Schools 392, .380-391.stackhou, J. & wll, B. 1997 Childrens Speech and Literacy Di culties 1: A Pyscholinguistic Framework.Lodo: whu.va d walt, C. 2006 Oral-Sensory-Motor & Respiratory Experiences. 2 Day wokho. Ct o CpD oAlld Halth poo, Clady Vlla, Kockback Halthca pak, Blat, n.ilad, 19-20 Ju.

Resources/ Malt, .malt.comptt Flou, .ttflou.co.ukToy ud o th uck ad blo actvt obtad om th whtl sto Thay

rouc tat kt 15 ack, 7 Almhou, st Momouth, Momouthh np25 3De, [email protected].

what hav you lat about you actcom audt? Lt u ko va th s09 oum at htt://mmb.chma.com/oum/.

reFLeCTiOnsDO i see THe VALUe OF OBTAiningsUperVisiOn AnD sUppOrT FOrCArrYing OUT AUDiT?DO i Use AUDiT TO eXAMine MY prACTiCeAnD iDenTiFY CLiniCAL reseArCHQUesTiOns?DO i eXpLAin TO CLienTs wHen AnD

wHY i AM Using THerApY THAT iseXperiMenTAL?

SLTP

A B C D e F g H i J K Lpatcat

Distanceblownincms

250

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in BrieF


ADVerTiseMenT

Actvty:exla: somtm you talk too at o m toudtad hat you ay. w a o to daa ctu o you ca talk at a lo d.Ak chld to thk o omth thy ca dato ho d. go th th chld lk whatabout a ta / la / ho?Dvd A3 to thd. w a o to da tham ctu 3 tm. Ak: Ho a oto ho ho at thy a o? Thy mht

da d l out th back o th ta o aho alk / tott / allo.Th ay Lt ut om umb o h toay ho at thy a o. what ould b thatt / lot umb? what umb ouldb a ood -bt umb? Thy mhtd hl to t a altc -bt umbhch th motat umb.Th dmotat talk at th att, lo-t ad -bt d. Chld lov thbcau t uy.ecoua th chld to act ach d.Fd a uy hym that thy ko ad akthm to at t. pa o mmb tad th act t at th dt d. Al-

ay fh o th tat -bt d.photocoy th ctu o mak mla ocomut, lamat t ad v to all volvdth xlaato o ho to u t ut tckabov -bt umb. U t du -o a a ahcad md to dvlo l-moto / cocto.

i B uotd by

In Brie is a new section o Speech

& Language Therapy in Practice

or 2009 suggested by readers to

showcase short, practical ideas.

One lucky contributor in each issue

will receive 50 in vouchers rom

Speechmark, a company which

publishes a wide range o practical

resources or health and education

proessionals working with people

o all ages (visit www.speechmark.net or more inormation).

Brie items (250-500 words) may

include therapy or assessment

tips or a description o a resource

you have developed. It may also

be a refection on the best piece

o advice I have been given, or

the things I wish theyd told me

at University. Although what you

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work, please acknowledge any

infuences. E-mail your entries to

[email protected].

Speed o soundLynn Griths xla a chld-dly vual tatoo d / ac o ch.

Fo oh th chld d to dcd co-tt o th ctu. numb ca o to ththouad; you jut allocat th ac o chto ach umb.

Althouh th o vual mblac tomy oal ouc o ato, i had totat ot:

Th da o at / volum / ucy / cla-ty / toato cam om Talkabout A

ocal commucato kll acka byAlx Klly .48. it omat catoo da- ad t - you dcu comoto ch / covato ad t doho you thk you co th thm ua mly chat.Th da o cal cam om soluto Fo-cud B Thay.

A thy , both o th too ab-tact o my clt ou to udtad, othy mohd to a mo chld-dly -tato.

Lynn Griths is an independent speech and lan-guage therapist in Northampton.

1.

2.

Am: To coua a chld to ak at a aoabl ac.Matal: A3 ht o a ad cayo.


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winning wAYs


ro to th uvy o adho you a cocd aboutyou ok / l balac, coth t ad u ad mot

o all - maa you tm. May admtod th t o jul all o lcoc lk a xt - o ot o xt -ccu act. w o ot choo th mtahoo th mtaho o lat, a quallytul, acky ad axty-lad ay tolook at th. i ma that may o youhav attdd tm maamt okhoo ad book o maaz t to b tmud commad. My admoth, ho lvdth u utl h dath at 99, alay dto tm a Th emy. sh ctaly hadouh o t to cod, ad i od homuch o h v i ubcocouly mbbd.Th th a my ath cotat cy,pocatato th th o tm!

A dt ali od hat you ha you codd

tm om a dt al? Dt ou clock,calda ad dadl, tm actually alluo. it mly a ay that ma dvd a attmt to ulat l. w a all amlath a to k holday m lk a day,o look o a lot chld h fv mutm lk a ltm. O a acy l lka a ad a chldhood o by a ah.

My ot that th ay th oblmvy ot th oblm. i ou l vualdlk lat, t ll m atc. i, o thoth had, t a a am o bllad, ttatly l calm, tll ad cu-abl. Thball ll at utl choo to mak th mov.i mak a mtak thy ll oly all to a

ockt. Thy ot oll aay to oblvo.it mht hl to cod o o mo o

th ou M:1. MeditationMdtato may m to may ol lka at o tm thy t a tt dooth th a mty md. But t vya om that. wh you tat you day thv a ty bt o mdtato, tm tak o alatc qualty. Bcau you hav tatd youday th th mall attmt at md t,i uaat you ll tat to thk abouttm dtly. That tm ll b v moctv you d at o you tll

vual th day o ll, accod tola, ad th om tm lt ov o you.

A timely considerationA uvy t out to a aml o sch & Laua Thay pactc ad cludd a o

quto about hch coc thy ould mot lk l coach Jo Middlemiss to add. w way

2009 bad o th o, b th ou M to hl u tad th tt o tm.

2. MediationTh ft o to mdat th youl:you d to tak o too much, you ablty tou tm a atul ay ad you ablty tobat youl u o ot k u th thjob. At th covato th youl, youd to hav covato th th olho attmt to olv th tm oblm thyou l. You ca la to ay o th fm,t ad u. Ad you ca bctv thout b a ol la.

3. ManipulationTh a thouht i havt ckd u ombook o oth ol, o i am u t byyou a a xmt. Clt hav ad to mthat th day ould b at th thyt xct ddt uddly com ad tak ov. what lay a ct amo maulato o ou 24 hou? Th oto tty ou ht tm. Thk o th day hth. evy day oly la to u vhth ad k back o hth a a abt. A bt jut o you, o o tho uxctdth that uddly d attto. sak toyoul a ay that v you a l o

authoty: Th hou o th day a m toallocat. i am cha o my day. Th day

ot cha o m. whl you ll v b cha o tm bcau t dot ally xt,a ht o cto cau a ht thk.You a th ut ad ot th ut.4. Minimisationpol th ac th hat a otxaat o catatoh a tuato,but that oc ca b vd. O youcomut you ca mm a documtthat you a ot ok o. itll at utlyou b t back to lay. so mm thth you cat t to. Thy ot t lot ooott. wh you ca t back to thm,ut thm back u o a ull c ad takacto.

pctvTh om autho uko ad to ba adatato o a old ih ay. it uttm to a dt ctv. noth o motat that you mtal ad hycalhalth hould u. A bok you o hlto ay tuato. Balac ad ctv,

ad ac o md ad body, a all talo you to b a ctv ad ooalmmb o octy.

Tak tm to ok,it th c o ucc.Tak tm to mdtat,it th ouc o o.Tak tm to lay,it th ct o tal youth.Tak tm to ad,it th ay to kold.Tak tm to b dly,it th oad to ha.Tak tm to lauh,

it th muc o th oul.Ad tak tm to lov ad to b lovd.

Jo Middlemiss is a qualiedLie Coach who oersreaders a condentialcomplimentary hal hourcoaching session (or thecost only o your call), tel.01356 648329. Her bookwith CD What should Itell you? A Mothers nalwords to her inant son is

now available.

reAD THis iF YOU wAnTCALMer THOUgHTseLAsTiCiTY OF TiMeTO Be in CHArge OF YOUr DAY


22/32

Df th tocAdducto amodc dyhoa a ocallayal dytoa that advly ct thomal cotacto o mucl ud to adductclo th vocal old Bayloet al., 2007; Hokyaet al., 2001; wat et al., 2005. Th abomalcotacto cau xcv am that ladto voc toa ad / o a tad-taldvocal qualty Hokya et al., 2001; watet al., 2005. Th cau o adducto amodcdyhoa ma uko; althouh t dly acctd to b uolocal, omautho blv that th may b motoalacto volvd Aa et al., 2007. pol thth codto hav otd adv ct ojob omac ad ducd ocal tacto

Baylo et al., 2007; wat et al., 2005.U o botulum tox jcto -

ally add a th may hamacolo-cal tatmt. Botulum tox, a uotoxcot, block th la o actylchol,hch ubqutly aaly th mucla th jcto t Aa et al., 2007. Al-thouh umou tud hav uotdth cacy o uch tatmt, coc -ad th mthodolocal qualty o thtud ad ottal o hamul d cta oly ctly b dbatd th lta-tu. sch ad laua that a -qutly volvd th ca o ol th

adducto amodc dyhoa. should cl-ca adv ad coua th clt tocv botulum tox jcto?

symtom lLocald jcto o botulum tox cautmoay chmcal dvato o thjctd layal mucl wat et al. 2005.Dyhoc ymtom uch a hoa, taad bath may b movd du to thducto o layal am Baylo et al., 2007.symtom l ca ovd movmt qualty o l o ol th adductoamodc dyhoa accod to th woldHalth Oaato modl. Th wold HalthOaato coua valuato om thctv o th o th th dablty od to udtad u latd to ocalatcato ad qualty o l Baylo tal., 2007. pol th adducto amodcdyhoa ot adv ct o ocaltacto ad job omac. Qualtatvmthod valuat th u o Botox Botox;All, ic., iv, CA jcto o cltychoocal ll-b allo o a att-authtc v th cotxt o th daly lvBaylo et al., 2007.

Baylo ad collau 2007 tvd 6adult cv Botox jcto o a lo-tm

ba. All 6 otd movmt voc qual-ty at cv jcto, clud om

ho otd that th voc had tud toomal du th tm th tatmt a

maxmally ctv. som alo otd m-ovd atcato th ocal ad commu-ty actvt but dtal o xactly ho may ot otd.

pOinT OF inFOrMATiOn:Althouh th tv udd aoudth al quto ad th x-c th Botox jcto, t ucla ho maytv volvd. Th autho alo ddot dclo ho th tv vfd todtm homolocal udl ocoduct qualtatv ach ollod.

Ovhlmly otvnothl, th o o th tud thatattmtd to udtad th mact o Botoxtvto o qualty o l. Th ult ovhlmly otv.

Hokya ad collau 2001 alo x-amd th ct o qualty o l. Tty-v clt comltd th Voc-rlatdQualty o L Mau V-rQOL Hokya& sthuama, 1999 o to th ft Botoxjcto ad th ad 6-8 klat. Th cycl a atd octvlyo ach ubqut jcto du a 18-moth od Hokya et al., 2001. V-rQOL a valdatd ad labl l-otd ma-

u that ha b ho to b ov tocha a vaty o oulato, althouhHokya ad collau v mtodhth th V-rQOL had b valdatd ool th adducto amodc dyhoa.Th ach oud that, o to jcto,V-rQOL co fcatly lo thth ublhd omatv data aoxmatly70 ot Hokya et al., 2001. patcatco fcatly movd om -tat-mt to ot-tatmt o ach ubqutjcto, althouh th matud o thtatmt ct a fcatly l atth cod jcto.

summ u th ca oth ootoi cocluo, th tud vdhav ho fcat ad damatcmo

speech & language therapy in practice, spring 2009

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