speech & language therapy in practice, winter 1998

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    quickly and eas ilyplaci ng notes on sheet music.

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    www.sol.co.uk/s/speechm agWINTER 1998(publication date 30th November)ISSN 1368-2105Published by:Avril NicollLynwood CottageHigh StreetDrumlithieStonehavenAB393YZTel/fax 01569 740348e-mail :avrilnicoll@sol .co.ukProduction:Fiona ReidFiona Reid DesignStraitbraes FarmSt. CyrusMontrosePrinting:Manor Group LtdUnit 7. Edison RoadHighfield Industrial EstateHampden ParkEastbourneEast Sussex BN23 6PT.

    Editor:Avril Nicoll RegMRCSLTSubscriptions and advertising:Tel/fax 01569 740348Avril Nicoll 1998Contents of Speech & LanguageTherapy in Practice r e ~ e c t the viewsof the individual authors and notnecessarily the views of he publish-er. Publication of advertisements isnot an endorsement of the adver-tiser or product or service offered.Any contributions may also appearon the magazine's Internet site .Cover picture:Speech & lang uage therapistElspeth Le itch with Cra igan d th e PTU (see page 9).

    News/Comment 2 Eating and drinkingdifficUlties ~

    Margaret Dumbleexplains how herteam responded to arequest to survey alladults with learningdisabilities foreating anddrinking difficulties.Conferencereport 7Speech a Language Therapy inPractice at the Royal College ofSpeech a Language Therapists'Communicating tne Evidenceconference.

    COVER STORY Speechdisorders 9practical reports, providinginput to Individual EducationPlans and setting joint targets forthe classroom.

    Electropalatographyis only availablein a few clinicalcentres. ElspethLeitch, FionaGibbon and LisaCrampin reveal theinnovative portable training unit.

    Reviews 13Stammering, speech sciences, voice.Reader offer 14Win a free copy of REACT, thenew computer software.

    II ICONTENTS~Augmentation orextra effort? 15Clients with aphasia can benefitfrom unique features of computertechnology. Alison MacDonaldand Linda Armstrong provide anevaluation.More reviews 18Linguistics, writing skills, adultacquired, early intervention, childlanguage, aphasia.Further Reading 20Learning throughdrama 21In a two-part article Myra Kersnerargues we have much to learnfrom the way drama sessionsare structured. Part 1 addressesBeginnings and Endings. Part II will focus on The Middle.

    How I write foreducation 24Therapists explain some of theways they are buildingeffective collaboration wi thteachers through writing

    My TopResources 30Jayne Comins, a speech andlanguage therapist and counsellor,chooses ten things she could notdo without when using counsellingin speeoh and language therapy.

    SPRING '99 will be published on 22nd February 1999IN FUTURE ISSUES dysphagia assistants Right from the Start drama (part II) velopharyngeal incompetence

    SP EECH & LANG UAGE Tli ERAPY IN PRACT ICE Wlr-Tl"E R 1998 1

    http://www.sol.co.uk/s/speechmaghttp://www.sol.co.uk/s/speechmaghttp://www.sol.co.uk/s/speechmagmailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]://www.sol.co.uk/s/speechmagmailto:[email protected]
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    NEWS & COMM ENT

    Be prepared The structure of drama sessions, with a clear beginning,middle and ending, is equally applicable to speech andlanguage therapy. Myra Kersner highlights the importanceof a beginning, of adequate preparation for the main workto come, if its potential is to be realised. In an ambitiousHow I write jo r education, again and again the point is madethat preparation prior to writing for or meeting withteachers is essential for collaboration to be effective. Weshould question how often our workloads mean we gointo meetings or sessions ill-prepared, or write reportswithout having first gathered all the information we need.What impression does this give of the profession and,more importantly, how much does it reduce the impact ofour involvement for clients?Margaret Dumble and COlleagues could have thrown uptheir hands in horror at a request from commissioners toidentify need for therapy, knowing they would be unableto provide any additional therapy required within theirexisting resources. However, through time spent in carefulpreparation, they came up with a method of surveying thepopulation which satisfied all parties.While this magazine recognises limited resources andstrives to offer realistic ideas, it also has a responsibility toprepare readers for changes such as developments intechnology which would benefit clients and services.Therefore, in addition to the magazine's recently launchedInternet Site, this issue features a competition to win newsoftware, offers other software for review and includes anarticle where Linda Armstrong and Alison MacDonald drawsome conclusions about the way computers will changeour therapy. Our cover story also provides convincingevidence that technology is for all and not just those inspecialist centres.The preparation involved in the RCSLT Communicating theEvidence conference was obvious, although the commentwas made that the profession's general lack of access tocomputers, printers and e-mail hampered its organisation.Attending the event gave me the opportunity to meetmany subscribers and to learn more about how you feelabout the magazine. My Top Resources for example isclearly a popular feature. This quarterwe are fortunate to benefit from theexperience of Jayne Comins as she

    shares her counselling ideas .A quote from the Conference sticks inmy mind: "Excellence is a direction nota destination." Readers can rest assuredthat Speech & Language Therapy inPractice is committed to this route.

    N0coll.Avril NicollEditorLynwood Cottage, High Street, Drumlithie5tonehaven AB39 3YZtel /ansa / fax 01569740348e-mail [email protected]

    Unacceptable d e l a ~ The system that provides equipment for everyday life, including communicalion aids', has come under fire from disabled people. Delays causing "prison-like" lifestyles are reported in a survey by SCOPE, with problems including bureaucracy, bias, confusing or incorrect information, finance and poor relationships with professional staff. The charity has recommended there should be national guidelines, centralised information, better planning an d more resources. ( . Nine per cent of res pondents had experienced problems with "s peech aids".) For information on Equipped for Equality, contact SCOPE, tel. 0171 619 7100.

    Ocrupational healthThe Health & Safety Executive is set to tackJethe problem of work-related ill health .A discuss ion do cument reflects preliminarywork an d is intended to stimulate ideasfor what can be done by 2010 to makesure that work activities do not makepeo ple ill. Con tributions are welcome.Developing an Occupationa l Health Strategyfor Britain is available free from HSE Books,tel. 01787 881165.

    Dysphasia [OlumSA voluntaryACTION FOR organisation forDYSPHASIC ADULTS people with aphasiais holding regionalforums to increasemembers' involve, Un locking words' ment in its activities.

    The Action for Dysphasic Adults (ADA)forum in Manchester included apresentation from members of the ADAWorking Party on the DisabilityDiscrimination Act (1995) , the first timepeople with dysphasia have participated inthis way.ADA , tel . 0171 261 9572.

    Better outcomes afterbrain injwyA coalition of orgalllsations and individualshas been formed to promote the interestsof survivors of acquired brain injury andtheir families and carers with policy makers.By ad dressing prevention, treatment.reh ab il itation, heal th, social welfare.education, housing, vocational an doccupational wo rk fin ancial, lega!, civilrights an d ethnic issues, th e U I>: AcquiredBrain Injury Forum a ims 10 real ise be tteroutcomes after brain injury In addition toresearch, debate an d planning, lob byi ng ofParliament bas ed on expert evidence ofbest practice w ill be a key function.Membership is o pen t profess io nals,organ isations an d individuals, includingthose wh o have sustained a brain injury.De tails. Elizabe th Han-ison, tel. 0115924 0800.

    SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 1998

    mailto:[email protected]:[email protected]:[email protected]:[email protected]
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    ~ ~ ra- - -;

    TechnologyshowSupporting children with speech an d language difficulties with Information and CommunicationsTechnology (ICf) will have a high profile at a

    major UK educationaltechnology event.

    t A S D A ~ BElT '99's seminar programme indudes speakersfrom AFASIC an d theBritish DyslexiaAssociation, and MikeDetheridge on New devel-opmen cs La support literacythrough symbols. Exhibitorsinclude Widgit Softwarewith their Writing WithSymbols 2000 an d Crick

    .. ...... .... ...~ ~_fIII__

    ~

    Software continuing its development ofma teria.ls for literacy and special needswith Wordbar, a flexible on-screen wordbank suitable for older children and

    adults and Quickfire, a new set of gridscombining speaking with writing for usewith Clicher 3. Topologika 's Speahing forM)'self (Communi cat io n, Speech andRe ading Developm ent), a CD-ROMdeveloped by Bob Black of the Down 'sSynd rome Association can be viewed onthe REM and Potential Software stands.

    BErr '99, 13-16 January 1999, Grand Hall, Olympia, London,Tichet Hotline tel. 01203 426458 .

    Matthew Crompton(third from left) whoplays PC Sam Harkerin television 's The Billhas his blood pressuretaken by his motherAnne (second fromright), a family supportorganiser for TheStroke Association.The actors are supportingthe charity's campaignto raise awareness ofstroke and how it can beprevented or minimised.Free in/ormation: tel.08453033 100/FREEPOST STROKEASSOCIATION.

    Awareness concernsFollowing research showing poor public understanding of speechan d language impairment, a national charity is launching a nationwide drive to raise awareness an d improve provision.A Gallup survey for I CAN found 24 per cent of those questionedhad no idea about speech an d language impairment, whil e theawareness that there was centred on stammering, lisps an d deafness rath er than other severe and more prevalent disorders. By raising awareness, I CAN wants to prepare parents and teachers an dprevent children being wrongly labelled as "difficult", "disruptive"or "slow learners", Chief Executive Gill Edelman said "Early identification an d specialist help can change lives, bu t without properrecognition an d understanding these children will slip through thenet and be denied the same opportunities in life as other children".A short film of experiences 0/ children and parencs "Giving Children AVoice" is available from I CAN, tel. 01 71 374 4422.

    Building a database of information about speech disability isbeing heralded as potentiallythe most valuable function of ane w state-of-the-art clinicalresearch centIe.In addition to facilitating interdisciplinary research an d providing an innovative clinicalservice, The Scottish Centre forResearch into Speech Disabilitywill use anonymous data fromclients to compile databases ofnormative an d disorderedspeech which will inform therapists' future diagnosis and management. Five recording studioslinked to a central record ing /control suite will en hance theed uc a tion of un d ergraduatestudents and th e developmentof new assessments an d treat-

    Project getsresUltsThe success ofan earlyintervention The Britishproject for Stammeringstammering Associationas led tospeculation thatstammering could beeradicated in future generations.Th e Briti sh StammeringAssociation 's Early InterventionProject aimed to inform parentsan d health professio na ls of thevalue of early re ferral to andtreatment by speech an dlanguage th erapists. Preliminaryresults show a doubling in therate of referral. Speech an dlanguage therapists have alsoreported that parents takingtheir children for therapy arenow more informed an d betterable to help their childthemselves.Th e BT supported campaigninduded the production anddistribution of leafletscontaining advice for parentson spotting the signs ofstammering and where to gofor help .British Stammering Association,tel. 0181 983 1003.

    ment procedures. Th e Centre,ba sed at Queen MargaretCollege, Edinburgh, also plansto extend co mputerised linksoriginally developed for cleftpalate centres in Scotland tobenefit other client groups.The Centre has a working dinicstaffed partly from local NHSTrusts. At a Reception to markth e opening, Clinical Co-ordinato r Dr Elizabeth Dean said,"These close links with the NHSwork in two ways. The linksensure the Centre dinic remainsgrounded in the reality of CUIrent speech an d language therapy practice. The links also DahleNHS speech and language therapists to benefit fro m the excellent faciliti es provided .SCRSD, eel. or31 317368 .

    SPEECH & lAJ'-JGUACE THERAPY IN PRAcnC- ncR 199 3

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    AL D

    Table 1 - clients referred fol lowing briefingsPROVIDER DATE OF

    BRIEFINGNO. OFCUEt-rrSNAMED

    NO. ONEXISTINGCASELOAD

    NO. OFNEWREFERRAlS

    NO. OFNEWCONFIRMEDEATING &DRINKINGREFERRAlS

    A 14 .12.95 18 5 0 0B 7.02.96 19 2 3 3C 27.02.96 52 5 11 9D 14 .11 .96 28 11 3 3E 23.04.96 30 3 8 5F 03 .11.97 49 1 0 0TOTAL 19 6 27 25 20

    As Table 1 shows, 20 clients (80 per cent) referred as a result of thebriefings were confirmed as having an eating and drinking problemdue to an underlying cause. Of the remaining 5 clients (20 percent) who did not have an eating and drinking difficulty, twoclients (and their support staff) were given advice by the speechand language therapist regarding more suitable food textures.These figures suggest that staff involved in the briefings were morelikely to be 'erring on the safe side' but were not generating unnecessary work for the service by excessively over-referring clients.Six providers were briefed in the reporting period. The remainingfive providers and the Day Services will be briefed next. It was originally expected that the service woul d be able to cover one providerper month but this was not possible. Factors such as the length ofnotice needed for all seniors to be present at briefings and thecomplexity and number of referrals resulting from several of thebriefings meant that the specialist speech an d language therapistneeded to spend more than the expected amount of time completing intervention before moving on to the next briefing.

    Table 2 - rating o f referred clientsEating an dDrinking Status Number o fReferred Clients Percentage o fReferralso =no eating anddrinking problems

    5 20%1 - minor problemsego no teeth,malocclusion

    9 36 %

    2 = physicaldifficulties modified texturesrequWed

    3 12 %

    3 = physicaldifficulties modified textureplus some supportego staff present

    3 12%

    4 =modif iedtextures and totalsupport requi'ed5 20%

    TOTAL 25 100%

    Planning based on needThe briefings also provided useful information for the lointCommissioners in terms of each client's Support Needs Profile.

    T h ~ s e are records which are used in planning services and allocating resources according to the client's present and prospectiveneeds. The client's eating and drinking status was rated from 0-4according to the type of eating and drinking problem diagnosedand the level of staff support needed at mealtimes. Details areshown in Table 2.

    Figure 1 - definitions and causes discussed inbnefing sessions1. What are eating and drinking difficulties? Taking food I drink from spoon I cup Forming a seal Chewing and moving food Moving food to back o f mouth Controlling palate to shut o ff nose Delay, incoordination or absence o f

    swallow reflex2. Causes o f eating and drinking diff icult ies Progressive neurological disease Stroke Tumours Cleft palate Surgery to th e head and neck Cerebral palsy Alzheimer's disease (l inked with olderpeople wi th Down's syndrome)

    Figure 2 - Warning signs o f a swallowing problemACUTE CHRONIC

    (Immediate) (long -term)

    coughing and loss of weightchoking

    dehydrationrequent chestgasping infectionsfor breath coughingand spluttering'gurgly' sounding at mealtimesvoice immediately refusing after eating I drinking to eat

    Figure 3 - referral form from briefingsEating and Drinking Difficulties Briefing for

    On(organisation) (date)HOUSE I SiTE ...... ... .. ................. NAME OF SENIOR'..........................CLIENT'S NAME REFER REFERRAL ALREADY ACTIVE WITH

    UNNECESSARY EATING & DRINKING TEAM

    SUMMARYREFERRAL FORMS COMPLETED ON1.2.3. - 4. ,.5,SIGNED HOUSE / SITE SENIORRECEIVED BYSPEECH & LANGUAGE THERAPIST DATE

    Staff awarenessClients with learning disabilities are usually dependent on theirstaff / carers for referrals to the special ist speech and language therapy service if they are showing any signs of having an eating and

    SPEECH & LANGUAGE THERAPY IN PRAcnCE WIi'.'TER 1998 5

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    ALD

    drinking difficulty. Staff carers need to be aware of what these signsare and how to make a referral. It is therefo re vital that all new staffare made aware of these facts by the senior support staff in the houses i n which they work as well as during their induction training.Effective use of resourcesThe briefing sessions are proving to be a useful way of responding to theloint Commissioner's request to identify clients who have eating anddrinking difficulties as well as raising staff awareness of these issues. Ithas also provided some data on the prevalence of eating and drinkingdifficulties in a sample of dients with learning disabilities in Lewisharn.Provided sufficient time is allocated to respond to referrals madeduring each briefing session, this process appears to be an effectiveuse of limited speech and language therapy reso urces. However, itmust no t be forgotten that the inevitable cost of pursuing such aproactive process is that other clients on the caseload with lowerpriority needs - defined in Lewisham as a low risk client who maybe in some distress bu t is not considered to be vulnerable - willhave to wait longer for a service.We now have other therapists o n the team who are already dyspha

    gia trained or are develop ing their skills in this field as part of thei rjob. This means we can manage the clients already referred and newre ferrals. However, we a re aware of the need to complete the briefingprogramme to the remaining providers and the day se rvices and areconsidering how best to carry this o ut with the resources available.Margaret Dumble is a speech and language therapist with th e LewishamCommunity Team for Optimum Health Services NHS Trust. The mainspeech and language therapists involved in the briefings project wereWendy Tuson and Ma gda Moorey. Wendy now works for NewhamCommunity Health Services NHS Trust.NoteThe term 'eating and drinking difficulties' subsumes the defi nition of'dysphagia' as defined in Communica ting Quality (RCSLT, 1990) andis the preferred term in this service for adults with learning disabi lities.ReferencesRCSLT (1998) Clinical Guidelines by Consensus for Speech andLanguage TherapistsRCSLT (1990) Commu nica ting Quality

    Questions lAnswersWhy is a full screening1 Screening means duplication, lack of client choice,programme waste of specialist time and ethical dilemmas if moreproblematic'? people are referred than can be seen.What are the benefits Educating the people who make referrals means directof a systematic rM ~ speech and language therapy contact can be targeted .briefing programme'?

    How can briefings be MM .MM Staff need to be able to see how the problem under dis-made most effective'? cussion relates to their clients.

    RESOURCE REVIEWS. .RESOURCE REVIEWS. .RESOURCEARTICULATION CHILD LANGUAGEEmphasis on production Quite earned away!

    Say and Do Articulation certificates at the end are rewarding. Cause and Effect ColorCards I. Role play assumi ng a role. OneWorksheets (various. p, t, k, z, Unfortunately, American voc abu- Winslow 23 .75 child plays the part of mother; onech,l) lary is used. There are not a huge This pack contains 24 two card plays the part of the naughty child.Photocopiable booklets number of American words but sequences of everyday events. The 2. Applying gen eral knowledge.Winslow 1999 each or 289.00 they are scattered throughout the cards are colourful, strong and Have you ever broken anything?(or 16 worksheets .Th e books use upper portable. Th ey introduce the basic 3. Relating personal experience.Th ese art icu lation books are well case letters which w ill not be concept of one even t leading to How did you feel when yourillustra ted and full of fun activities popular with teachers.The Kwork- another. Th e pack is grouped into favouri te toy was broken?such as matching, odd one out, hid- book gives k for cat and cup which four categories: 4. Pro blem so lving. How can youden pictures and join the dots, with again is confusing for chi ldren. Accidents, eg. Th e ch ildren play mend that toy?amusing drawings that children will Some of the workbooks are more rough ly and break the doll. Some of the cards are suitab le forenjoy. They focus on articulation useful than others. I have used the Difficulties, ego The boy puts too adult cl ients. Personally I do not likework in a well structured way, The P one with two dyspraxic children much sa lt on his dinner and does the card of the boy playing withsounds are given in isolation, wi th a who ne ed lots of practice and not like the taste. matches and setting fire to thevowel. in words (initial, medial, final reinforcement and my colleague Time, eg.Th e woman plants a bulb papers as it sets a dan gerousposition s) and then at phrase level. likes the L one. The Z workbook is and eventually it blossoms. example.The same sound is repeated in not recommended and it would Emotions, ego The woman receives I used the cards in a group situationman y activities giving lots of scope be very expens ive to buy the a present and is del ighted with it. and the children rea lly enjoyed thefor reinforcement without the task complete set. Th ey can be used for basic lan- role play, One litt le girl had to bebecom ing dull and repetitive .There Th ese books are fun for ch ildren guage work such as cause / effect, discouraged from hitting her friendare some examples of listen ing and therapists and great for home sequen tial thinking, organ isation of as she was quite carr ied away,wo rk, minimal pairs and auditory practice. Th e drawbacks are the thoughts. Th ey cou ld also be used Th erapy ma terials are alwaysdiscrimination but the emphasis is American vocabulary and the edu- in a wider way, for example expens ive but, if your budgeton production. Th e congratulation cati onal aspects. through: allows it. this is a useful set to buy

    Ann Gosman is a Speec h and Language Therapist with Orkney He alth Boord.

    SPEECH & lANGUAGE THERAPY IN PRAGnCE WINTER 1998

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    CONFERENCE

    C O N F E R E N C E R E P O R T C t e eVI ence Delegates at the Royal College of Speech & Language

    Therapists' Communicating the Evidence conference wereasked what they had heard that would encourage them to

    LcxaJ researm arddevelqxrentSeveral delegates plan to approach theirmanagers with ideas following the twopart presentation by Margaret Meikle fromPortsmouth HealthCare NHS Trust.[n outlining he r service's local research an ddevelopment strategy, which included collecting an d collating all papers held in herdepartment so ideas could be shared, sh estressed staff need: basic research methodology library skills critical appraisal skills training. Clinical governance challenges all staff to take responsibiliry for what they do. She believes it is up to the manager to: make sure all staff understand this provide support in life long learning be explicit about guidelines an d standards implement change as a result of audit ensure the service is knowledge based and knowledge driven . TheWILSTARR effectDeirdre Birkett and Sally Ward revealedthe results of their follow-up study of thefirst W1LSTAAR' children, now aged sevenan d believe they suggest there is an earlyperiod where making environmentalchanges ca n have a considerable and la s t-in g effect.Comments from delegates included:OUT Trust is choosing between introducingWILSTAAR and Hallen. Being here has givenme more idea of the research behind theapproaches.JulieI was interested in this follow-up research.Service managers need the best informationand IlI/ll here 10 collect information and maliCdecisions regarding priorities.DeirdreI worll with children in foster care. It is diJJ /cult to persuade social worlwrs of the need faTearly referral. Sally Ward's wadi gives me ex traellidence.Melanie

    change their practice.Gathering ideasOn e of th e main benefits of the Conference isnetworking and meeting peop le, but I havebeen gathering ideas too. I work in the Forcesand now want to look at considering providingsupport to secondary schools. I would also liketo audit how our referrals have changed, to seewhere we should be targeting rraining.DawnMale than impaimlentIt's good to see the confidence and diversity ofthe profession. I would have liked the conference to be more creative, though, rather thanbeing organised mainly by impairment. Forexample, learning disability appeared underrepresent ed but there are many links acrossclient groups that could have been shown if different themes had been chosen.Carole

    Making prioritiesSeveral speakers came up with good ideas onprioritisation. Ann Rice for example had reallythought through this complex issue - ethics,efficacy, ef ficiency etc. - and I plan to ask herfor a copy of her framework for good practice'.With another delegate, / am considering setIing up a study day on p1ioritisation.Sue Summary of framework l.specify the health benefits 2.consider the values of all involved 3.set criteria for priorities 4.examine for ethics 5.develop ranking measures 6.record measures for decision making 7.inform purchasers / clients / users B.review an d revise. Readiness for therapyI was impressed, along with many others, byPamela Butt's non-lierbal reasoning test ofproblem solving in aphaSia, as she is suggestingthe clients without these skills are not ready forrelwb. I hope it will be published S0011.Also, after attending Maggie lohnson's workshop on inter-disciplinary outcome meaSllre

    mellt, / will definitely be looking to do something similar. It was useful to have the wn'tten proceedings as I found it frustrating that, with so much going on at once, I couldn't attend everything / was interested in. CatherineTherapy in actionI like to see other therapists in action so partic ularlyenjoyed the video case study of a five yearold boy who, following two years of therapy, wasstill lin intelligible and so aware that he refusedto cooperate with confrontation naming forassessment. Instead, the therapist focused onwhat he could do, for example, discriminatingbetween real words and words containing hiserrors as spoken by the therapist.I would have liked more opportunity for questions in the sessions and, as a generalist, foundit impossible to cover all my areas of interest. Itwas good to have the opporwniry between sessions to meet other therapists I refer on to, as /am rather isolated in my job and don't oftenget the cha /lce.janePoster possibilitiesThe poster presentations have given me ideasabout how to share information about what weare doing . The therapists from our local TI1ists gettogether for study days and a presenuuion alwaysseems such a big thing - this would be a goodaltemative. The posters were all interesting and itwas good to see what other people are doing .AngelaThe video viewRay Wilkinson gave a presentation on aconve.rsation analysis approach . A perso nwith aphasia an d their spouse videoedconversations in natura,! settings an d th enviewed an d discussed the recordings w imthe therapist. In the case example used,both partners thought the spouse wabeing helpful by correcting 'errors' wh i hactually ha d no impact on th e mean in g ofwhat was being said. Seeing the vid 0.. ...... ............... .. .......... ...,o 'ltiIlUd 111''''' ~

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    CONFERENCE

    helped them to see how much it aduallyinterfered with conversation and alternative strategies were suggested.I have used audio recordings before but it's notthe same as being abLe to see what is happening too. I have also been in a situation where Irecommended phonemic cueing to carers as astrategy for a client with word finding difficul-ties but it ended up with them guessing wordswrongly and the client haVing no flow to herconversation. This could be an effec tive way offinding a balance.AshleighTaigeting volunteeisYou would assume that more training of volunteers working with people who have had astroke would effect change, but it doesn't actu-ally correlate. It was reassuring to find that allareas of the country have this difficulty. Actionis needed at a national level, but I am planning to target certain volunteers and developprotocols for people being volun teers.Helen

    Diiving del iveiyMy idea that the carer's perspective shoulddrive service delivery has been reinforced, so Iwill continue down that road.ThelmaClinical teachingThe session on student learning seems tohave converted delegates:In our department , we don't take many studentsand always assumed they would be a burden.I've now realised that they have time to do indepth analysis and case studies which can bevery useful if the results are fed back to clinicians.RachelI heard about PATSy (Patient Assessment TrainingSystem), a tool developed for student training, butI think it would be lISeful for clinicians LOO, especially if you had students on placement. I also seenow that groups or pairs of students can be anopportunity rather than more work.LynneI've learnt that peer placem ents with biggroups are a good idea , using time of therapistsand students effiCiently.VidaImpioving inforTnationAfter hearing about a Norwich project 'into theviews 9f people with dysphasia, I'm going to offerclients more information in future and give moretime to hearing the views of carers. It s applicable to adults with a learning disability too.Lucy

    Education plansI'm planning to put together a specific curriculum to mirror the National Curriculum, sothat th e children we see are really accessing thecurriculum and not sitting in and missingloads.NancyClaire Topping 's paper on team workingbetween educational psycho 109), language support and speech and Language therapy formainstream children provided a good mod el.Alison

    Researching theevidenceIn what Chair Sally Byng described as aligh t-hearted way of looking at a seriousissue, on e group debated the motion: ThisHouse believes that current research isirrelevant to clinicians developing evidence for the effediveness of interventionby speech and language therapists.Rebecca Lacey and James Law presentedthe opposing arguments and there waskeen interest from the floor. Some of thekey practical points raised were:1. research evidence should be made moreaccessible to clinicians, with a variety ofpublications used2. there is a perception of polarisationbetween clinicians an d academics, an d aneed for more collaboration to bridge thegap3. we should address how to move fromsmall-scale descriptive studies into largescale studies4. clinicians must have access to the tools ofresearch - a computer, printer an d e-mail5. the 'exclusion criteria' for subjectsmeans research does not always appear torelate to 'real' clients, an d there is a needfor a different type of research focus, forexample on packages of delivel)' an d qualityofJife6. there should be publication of negativeresults as well as positive ones, so we canstop doing what doesn ' t work and do moreof what does.The conference generally has prompted anenthusiastic view of research:I now see that research is achievable locally - Ididn't think it wO'uld be.ChristineI like the idea of a whole departmentala{l(Jroach to research and development and willencourage my manager to do a library skillsworkshop.Janet

    One of the speakers managed to get mon ey outof their Trust for an oucome measure - I'll nowexplore the possibilities of that for myselfDorothyIn Portsmouth HealthCare NHS Trust, allnewly qualified physio, occupational andspeech and language therapists have to do aproject in their first year. I liked this idea , butfor longer-serving staff too.JanI've almost been convinced to write up myresearch into training staff and carers of peop lewith learning disabilities.TrishaQualrty assuredSeveral delegates mentioned their interestin Signed up to Quality, RCSLT 's newAccreditation scheme. It is seen as the logical step after professional standards andregistration, as it is an independent measure of a service's compliance with theidentified standards. The process can alsobe used by a service to bring about changefor the better.RCSLT has developed the scheme in partnership with the Health Quality Service(formerly King's Fund OrganisationalAudit) who will train experienced speechand language therapists to act as externalassessors ('surveyors').Launching the scheme, Philip Turner said,"The world of the public sedor seems continually'to be reorganising and puttingchallenges before us without necessarilyshowing us ho w to deal with them.Accreditation is a powerful weapon in ou rarmoul)'.Accreditation Information line: 017] 6] 36400

    Th e Royal College of Speech &.Language Therapists' conferenceCommunicating the Evidence - theCase for Speech and Language Therapyran from 15th - 17th October 1998 atthe Adelphi Hotel in Liverpool.Approximately 500 attended, joined by250 students for their conference onthe 17th. There were over 120 papers,15 workshops and 45 posters.Proceedings are available in theInternational Journal of Disorders ofCommunication Vol. 33, Supplement,1998. Details: RCSLT, 7 Bath Place,Rivington Street, London EC2A 3DR,tel. 0171 6133855.

    students report from the Royal College of Speech & Language Therapists' student conference advice from a new graduate

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    Portable trai for speech disol1 ers W hen conventional speechand language th erapy tech niques did not have muchimpact on the speech ofCraig (1 0), the first autho r sought access toelectropa latography (EPG) as it hasbeen fou ndto contribute to three central clinical tasks:I . speech assessme nt and diagnosIs: EPGrecords precise details of abno rmal lingualart iculations often not detected by perceptual

    analys is2. measurement of change: EPG data recordedbefore and after therapy prov ide an ob jectiveway of monitor ing progress and quantifying heeffects of therapy3. provision of real-time visual feedback: thisfacility helps clients to monitor and changetheir articulation patterns as part of a therapyprogramme.Cra ig was having particular difficulties pro duc1ng ve lar sounds, consistent ly frontin g the m tothe alveo lar place of art iculation. AlthoughCra ig has long-term speech and language therapy needs, it was felt EPG wo uld be potentially usefu l In reso lving his specific prob lem withvelar front ing. An innova tive approach wasrequired, howevec as Craig lives 140 miles fromthe nearest centre offerin g this technique.

    Safe procedureThe tongue is one of the most importantspeech organs, an d is actively Invo lved In theprod uction of the majority of consonants andvowe ls. Howevec its behaviour is notorious lydifficult to reco rd due to itsvisually inaccess iblelocat ion and the speed and complexity of itsmovements. Eectropa latography (EPG) is asa fe procedure that records detai ls of the locat ion and timing of tongue contacts with thehard palate during speech (Hardcastle et al.199 I Hardcastle and Gibbon, 1997).An essen ial com ponent of EPG is a custommade artificia l palate, moulded to frt as com fortably as poss ib le against a speaker's hardpa late. Embedded in It are 62 electrodesexposed to the Ingual surface. When contactoccurs between the tongue surface and any ofthe electrodes , a signa l is conducted to anexternal processng unit and disp layed on acom pute r- screen. EP G registers characteri sticpatterns for the English sounds ItJ, Idl, Ik/, I9 I,lsi, hi, ii I, Id} i,M/, /1/, In/ and I fJ l. The value ofEPG in the trea tment of articulation disor-dershas been demonstrated in a number of studie s(M ichl et ai, 1993; Dagenais et al. 1994; Dent etai, 1995; Mo rganBarry, 1995).

    Poor accessibilityAlthough EPG has been show n to be a valuable chn ical tool. a numbe r of facto rs have prevented its widespread use in clin ical contexts.Frstly, EP G requires a PC (computer), whichmakes it a relatively expens ive techn ique andnot cost -effective for clinics with lim ited caseloads of cl ients requiring EPG therapy.Secondly, there may be a lack of tech nical orspecialist support for clinicians who wish to useInstrumental procedures. EPG IS relat ivelystlClightforward to operate, but some techn icalsupport is often needed in the initia l stages. Inaddition, data analysis is a time-consu ming taskand interpretat ion is aided by th ose with speCialist EPG knowledge.Th ird ly, although familiesare ofte n prepared to travel for one-off consultations at centres with an EPG system, thereca n be pract ica l and finan cial difficulties wherefrequent and I or numerous sessions arerequired.In an effort to solve the accessibi lity problem. aporta ble traini ng unit (PTU ) was designe ~W ilf Jones Gones and Hardcastle, 1995) 10 beused in conjunction wi th the Reading EPG3system. It is envisaged that centres WIth th t: full

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    Figure I.A portable training unit(PTU) showing a typical alveolarcontact pattern, ego for a./tl,/dlor Inion the screen

    disorders associated wi th cleft palate (G ibbonet ai, in press). In the circumstances, projectstaff also allowed Craig the use of a PTU.

    Range, timing andaccuracy affectedCraig has a non -progressive neurolog icallybased developmental motor speech disorder;diagnosed as cereb ellar ataxic dysarthr ia (a lso

    (a) Craig's production of word-initial /k / in Kevin (transcribed as It)).. .. .. "s.. o . ~ o . ~ o.:!oo ~ ~ ~ ~ ~00 .. 00 , 00 0 . 00 0 - . ~ - . ~ - . ~ - ~~0 . .0 0 00 .. 00 00 . .. . 00 00 .. . 00 00 . .01:em. ThiS n itia l period of intensive therapyou ld be eva luated and therapy would continue using a PTU locally if needed.Accommodation 'or a week in Glasgow and asix hour return Journey from Argyll 0 Glasgowwere arrange d.The EPG assessment confirmed that Craig'sve lar targets were fronted to an alveolar placeof articulation. Figure 2 shows two examplesofCraig's EPG patterns for velar targets before

    t h e r a p and compares the se wrth a normaladult speaker's patterns of the sa me targe ts.The palatograms in Figure 2 are numbered andread from left to right. and occur at 10 msintervals. Three frames are marked: (a)approach to closure (b) maximum contact and(c) release of closure. Craig's production of 11

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    00 . . . . 00~exts, placement reverted to alveolaeThe effectof the Iii vowel environment in faci litating IkJwas presumably due to the tongue being in arelat ively high position in anticipation of the following vowel. This high position could haveencouraged tongue bod y movement upwardtowards the pa late for velar placement.Maintaining alveolarsAfter three weeks of therapy using the PTU,open vowels were introduced in consonant vowel (CV) contexts, init ially without accompanying voic ing for the vowel. Gradually, as velarplacement became more con sistent, othersounds such as alveolar plosives were introduced to alternate wrth the target velae At first,alternating between IkJ and Itl had the effect ofde stabihslng alveo lars, maktngthe EPG patternsfor alveolars appear var iable, imprecise andsometimes at a more retracted palatal place ofarticulation. This meant that Craig used thePTU not only to ass ist in establishing velars,butalso to ensure that accuracy of placement foralveolarswasma intained. In the last four wee ksof therapy, velars in a range of contexts wereintroduced, including: voiced velars /(j. Irj in VCsequences: voicing of vowels In CV and CVCsequences: velar plosives IkJ and 191 n withinword contexts:and IkJ in consonant clusters.Other feedbackTherapy sess ions Included time to pract isearticulation skills with and without the artificialpalate In stu, to ensure that articulatory skil lslearned with the ad of visual feedback arema intained even when visual information IS nolonger provided . The absence of visual feedback meansthe ch ild hasto re ly more on otherfeedback channels such as tactile , kinaestheticand auditory cues to maintain accurate pro du ct ion. Ultimately, the child will depend onfeedback from these channels rather than thevisual modality when prodUCing and monitoring speech in naturalistic contexts. It is therefore good EPG pract ice to remove the visualInformation as soon as the child can achieve anapp ropriate art culatory gesture (seeMorganBarry. 1989 and Dent et al, 1995 forsummar ies of EPG as a therapy procedure ).In add ition to discuss ing he EPG pattern s fordiffe rent ta rget sounds, Craig eVas encou ragedto describe the new ge>tures in terms oftongue movement and placement and howthey sounded to him. Craig expe rienced no difficu lt ies in relating the EPG patterns to theresult ing perceptual conseq uences of hisbehavioue Figure 3 showsexamples ofCraig'svelar targe ts after the period of therapyusing the PTU. Craig's EPG patterns are againcompa l-ed wi th a norma l adu lt speakers pro ductions. The se EPG sequences show app ro priate tongue-palate contact in the velar regionfor ve lar targets, illustrati ng how Cra ig's productions of 'Ie lars Improved fo llowing therapy.Art iculatory placement for velars is clearlymuch more like a normal speaker's after therapy. However. one obviou s difference IS that

    (a) Craig's production of word-initial /k / in Karen (transcribed as [k])"

    0 . . .. . 0 . 00 . . . . 00 ". . ... 00 -0 .. . 00 0- :::;, . OOO - . - . ~-. ""'''''..."""ACTOJ

    0 .... . 00 -.

    (b) Normal adult speaker's production of word-initial /k / in Karen

    o . 0 .. . 0 .... 0 . . . . . 0 00 . . . . 0 00 .... 0o 00 " 00 00 .. 00 00 . .. 00 00 . CO 00 .. 00oooooooo0 . 0 00 . 00 ~ -

    (c) Craig's production of within-word /k / in making (transcribed as [kD

    . 0 . . . . 0 0 .... .. 0 0.. ..0 0 ...... Q 00 .. . 00 00 .. . 00 . . 00 . . . . 00 00 .. .. 00 .00 00 0 . 00 0 00 0 . 00 0 00 0 .. 000 -. .- - - - - - ,"""""o c.oso>l0 ..... 0 0 .... 0 0 .. .. 0 o .. 0 o .00 . . . . 00 00 .... 00 00 . . .00 0 0 0 0 00 .. , 00 00 . .0 0000 . 000 00 .. .0 0 0 0 0 .. . 00 0 00 .... 00 00 00 00 ,. , 00~ ~ 0000 _-- ........ o. ""'""""(d) Normal adult speaker's production of within-word /k / in making

    ".0 .. 0 0 .. ...

    00 .... 0 00 .... 00 00 . ..

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    +- continued from previous page .... .......... ... ... . the individual needs of the chi ld.This was alsotrue in Craig's case, Although visual feedbackwas an integral part of his therapy, especia lly atthe initial stages, additional strategies wereused, including heightening Craig's meta linguistiC awareness of the articulato ry featu res ofsound classes, encouraging discussion of relevant aspects of speech production and monitoring the commu nicat ive adequacy of his ownattempts at productions ,The combinat ion of the Reading EPG3 systemplus PTU s potentially enables clients living inany geograph ical area to have access to EPGthe rapy. Th rough collaboration and effectiveteam work it is po ssible to extend the use ofinnovative techniques, such as EPG, to a rura lstuation to the satisfaction of client, carers andclinicians al ike,

    Elspeth Leitch is a speech and language therapistwith Argyll and Bute NHS Trust Fiona Gibbon isbased at Queen Margaret College in Edinburghand Lisa Crampln is a specialist speech and language therapist at Glasgow Dental Hospital.AcknowledgementsThe Reading EPG3 and the PTU device weredesigned byWilf jones, CleftNet Scotland pro

    vided Craig wrth the use of the PTU. CleftNetwas funded by the Scottish Office Departmentof Health (Grant number KJRED/4 /C30 I). Forfurther info rmation contact eithe r ElspethLeitch, Depa rtment of Speech and LanguageTherapy. Aros Blarbuie Road, Lochg ilphead ,Argy ll PA3 18LD (01546 604 923) or Dr FonaGibbon, Department of Speech and LanguageSciences, Queen Marganet College, ClerwoodTerrace, Edi nburgh, EH 12 8TS (01 31 317 3000),ReferencesDagena is, PA, Critz-Crosby. P and Adam s, j(1994) Defining and remediating persistent latlisps in children using electropalatography:preliminary findings .journal of Speech-LanguagePathology 3, 67-76,Dent, H.. Gibbon, F, and Hardcast le, W (1995)The application of electropalatography (EPG)to the remed iation of speech disorders inschool-aged chi ldren and young adults .European journal of Disorders of Communication30, 264-277.Gibbon, F, Cramp in, L, Hardcastl e, W J., Na irn,M, Rauell, R, Harvey, L, and Reynolds, B, (inpress) CleftNet Scotland : a network for thetreatment of cleft palate speech using EPG. Toappear in Proceedings of he 1998 Conference of

    the Royal College of Speech and LanguageTIlerapists,Hard castle, W. j, and Gibbon, F (1997)Electrop alatog raphy and its clinica l app lications,In : M.j. Ball and C Code (eds.) Instrumenta lClinical Pho netics, Whu rr Publishers: London.Hardcastle, W j. , Gibbon, F,E. and jone s, W(199 I) Visual display of tongue-palate contact:electropalatography in the assessment andremed iation of spee ch disorders. British journalof Disorders of Communica tion 26,4 174,jones, W, and Hardcastle, W-J (1995) Newdevelop ments In EPG3 software, Europeanjournal of Disorders of Communication 30, 183m,Michi , K, Yamashrta, Y, Imai, S. Suzuki, N, andYoshida, H. (1993 ) Role of Vsual feedbacktreatment for defective lsi sounds in patientswrth cleft palate. journal of Speech and HearingResearch 36, 277-285.MorganBarry, RA ( 1989) EPG from squa reone: an overview of electropalatography as anaid to therapy. Clinical lingUistics and Phonetics3,81-91.Mo rganBarry, RA (1995) EPG treatm ent ofa chi ld with Worster-Drought syndrome .European journ al of Disorders of Communication30,25 6-263. 0

    QuestionsWhat are the main features of theportable training unit?Why is the full Reading EPG3 alsoneeded?How does EPG therapy relate toother approaches to therapy?

    AnswersThe pru is lightweight, relatively inexpensive andused for therapy only.The full system facil itates thoroughassessment and monitoring of progress by aclinician with specialist knowledge.EPG is used in a systematic way along withencouraging self-monitoring and meta-linguisticskills.

    R E S O U R C E U P D A T E...R E S O U R C E U P D A T E .. . C,?mpetitionP u r ~ h a s i n g aphasiaservrcesA revised guide for Commissionersand Managers on purchasingspeech and language therapy services for people with aphasia isnow available.The British

    Aphas io logySociety leafletincludes: a definition; incidenceand prevalence;how speech andlanguage therapyservices can help;and evidencebased treatment.For a copy, tel.Susie Parr on...-- .......-- 0117921 1192.- ~ -

    New signsA third job-specificsigning resource isavailable fromSIGNALONG.Horticulture&Animal Husbandryprovides 800 signsfor organisationsoffering trainingand for commercialand shelteredworkingenvironmentswhere people withlanguage difficultiesare or could beemployed.From SIGNALONG,price 17.50, tel.01634819915.

    winnersThe winners of the RDLS IIIAdVOcacy not enough in the Autumn 98 issueResearch showing that support systems fail competition were Barbarato help parents with learning difficulties has McLennan and Emilyled to the publication of good practice guid McArdle from Wirral andance for advocates. West Cheshire NHS TrustThe action research project Parents with their no-nonsenseTogether used an advocacy approach to entry:challenge discriminatory views regarding We believe that RDLS III is ancompetence and to lighten the load on fam essential tool fo r the new mil-ilies by reducing the environmental pres lenium.sures that undermined them. The reportAdvocacy for People with Learning but seriously ....... we've seen it.Difficulties evaluates the project and gives we like it,

    "advocacy can successfully challenge specif we want it,ic instances of bad practice, but it cannot we're broke!change the system that generates it." Thanks to all entrants andAdvocacy fo r People with Learning Difficulties, sorry there can only be one13.95 + pap from Pavilion Publishing, tel. winner. The RDLS III will be01273 623222. reviewed in a later issue.

    detailed practice guidance. It accepts that

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    REV1EWS

    HIGHLY RECOMMENDED HIGHLYRECOMMENDEDHIGHLY RECOMMENDED HIGHLY RECOMMENDED

    Reassurance and hopeThe Stammering Handbook - aDefinitive Guide to Copingwith a StammerJenny LewIs with the BSAermiflonISBN 0 091 8 6602 I

    Weighty but worthwhileThe Voice Clinic Handbook Tom Harris, Sara Harris. John Rubin & DavidHowardWhurrISBN 1-86156 0346 45.00Thisbook is wri en for awide range of spec ialists andprofessionals n olved in the diagnos is and managemen t of voice pattents. It takes its unique perspectivefrom the vantage point of a we ll-estab lished mult i-dis

    Intelligible, ~ I i ~ a c t i c ,non-patromslngThe Speech SciencesR. KentSngularISBN I 565 93689 2 33.00You think acoustic phonetiCs IS just forfanat ics? Speech pro ductron and perceptionmodels are muddles to you?Your physicsofsound lectures were held apparently in a8. 9This IS an inspiring book that offerspractical support to stammerers andthose who live or work with them . It

    examines stammering from the 'inside'so that the reader begins to feel someof the frustra tIOns and ach ie ements orpeo ple who stamme r. To Illustrate theimpact of dysfluency, life sto ries arewoven into each chapter. giving a veryperso nal touch to the bookEncouragement is provided aongsideadv ice, so that the reader leaves eachchapter convinced th t stamme-ing neednot dominate a person's life. The authoris refreshingly realistic and honest aboutthe difficulties of being a stammerer butenco urages the reader to look beyondthe dysfiuency, taking a pro-actve role inovercoming the difficulties.Jen ny Lew is discusses the impact ofstam mering on ch iidl-en. teen agers andadults. including the prob lemat ic issuesof poo r self es eem and limited confi dence. The adv ice prov ided recogn isesth e need for a wide ariety of supportthat meets ve ry Indiv id ual ne eds.Speech and language therapy IS discussed as one pal-t of the process ofchange for the stammerer, with understanding and acceptance of the dysfluency and developing communicationskills play ing an equal part. There arevel-y helpfu l techn iques such as desensitisation. block mod ification. slow prolonged speech. and al so complementary therapy. The author avoids makingjudgements abo ut how appropria teth ese me thodsare,alowing th e readerto make his or her own Judgementabo ut the various types of treatmentavailable.This book provides reassu rance andhope to stammerers. It is written in avery personal and easy style that wi llapDeal to many readers and thereforewin be particular ly useful for stammerers, thei r fami lies. friends and col leagues. It is unusual to fi nd a boo k thatISpract ica, reassuring and a pleasure toread: highly recommended!Koren Da 'lles is Clinical Co-ordinator forSpeech and LanguageTherap y. SockportHealthcare NHS Trus c.

    HIGHLY RECOMMENDED HIGHLY RECOMMENDEDHIGHLY RECOMMENDED HIGHLY RECOMMENDED

    ciplinary vo ice clinic and recognises that dysphonia isasympt om resulting from multiple causes and individual predisposing facto rs.Th is s a weighty boo k. not easy to read but cer tai nlyworthwhile to use as a resource and refe rence po intThe bo ok is roughly divided into three part s.The firstpart is a sol id review of the structural anatomy andphysiology 0 the vocal and respira tory tlacts. It pro vides a helpful overview of th e most commo n nonmalignant ca uses of vo ice disorders.The second part of the book deals with a number oftherapeutic approaches and ISprobably the most interesting for the speech and language therapist wo rkingwith voice. It provides an outline of assessment considerations, an overview of traditional voice exercises. anddescribes briefly Jo Estill 's Compulsory Figures and theAccent method - two approaches used in teaching control over vocal mechanisms. It makes frequent referencesto the many facets of voice therapy where Input fromother professionals may be of benefrt and providesexamples where manual therapy and psychotherapymay be helpful in either individual and / or glUup sessions. Manual therapy and methods are desm bed insome detail but wrt:h the proviso that manipulation andpalpation shou ld on ly be carried out by experiencedpractitioners. This particular chapter may feel dauntingbut there ismuch that can be learned from it in term s ofan Increased awareness of po stural problems and effectson the voca l mechanism. A chapter on the treatm ent ofpsychogenic factors in dysphonia takes a Feudian perspective in that unexpressed fe elings and emot ions arethought to be somatised in the body reSUlting in hypertonicity and dysphonia.A group approach based on psychotherapeutic prinCiples IS out linedFurther chapte rs in th is section deal wi th specifICproblems encountered by professional and semi-professional singers and provides examp les of the type ofpre ssures these client groups may be subjected t o. Auseful chapter outlines some of the drugs which havean effect on the vocal tract. The re is much to gainfrom this chapter although it is written in a less thanuser-friend ly form; a char t outl ining major drugs andeffects on the voice would have been helpful here fOIthose not familiar with pharmacology and biochemistry. Pros and co ns of phonosurgery are discussed ina brief chapter. with some information about the possible outcomes for voice qua lit y.The final sect ion deals with current technology andthe objective measurement of voca l qualit ies.Overall. this boo k provides a wealth of materiaJ forthose interested in vo ice, with a very clear focus oninte rdisciplinary approaches. It is Informat ive in its deta iland can be used as a resource for individual therapistsworking without a vo ice cl inic as well as those workingor starting to wo rk with in a multidisciplinary team.Esje Prins is 0 Specialist Speech and LanguageTherapistwith Harrogate Health Care NHS Trust

    fore ign language? The re lationship betweennet ral substrate, phYSiology. coustics and perception of speech is as clear as a foggyNovember day to you? Books and articles youhave turn ed to for help are laden with mpenetrable jargon)If these sc enarros apply, or you are smp ly eagerto delve into these fasc inating areas so centralto lhe speech cl inic and the knowledge baseand research that lies behind it, then Kent'sbook. with its clear diagrams and intelligible,didactJc, yet non-patronis ing style. is a recomme nded read.Fourteen chapters , the fil,t an overview of lhebo ok. Introduce the ma jor branches of speechsc ience. Chapter 2 explains baSI C concepts inthe physics of soun d.Chapte (s 3-7 deal wrth thebasc arlatomy, physiology and neural substl-ateof the speech and hearing system. Chapte -5 8I I outline physiologcal and acou stic phoneticsand speech percepti on and pro duction Wth anease that readers whose nightmares are pop ulated by te rm s and formu lae from these fieldscan never have guessed pos sible.Chapter 12 high lights appl ications of speech sciences to commun ication disorders; forensicphonetics; digital speech co ding; hum an machine speech comm unications;and speech Inart and culture.The penu ltimate chapter considers what makes speech Uniquely hum an.Theone co ncern embryologcal developm entof th e speech organs. A glossary supp lementsdefin itions in the main textThis is an in troductory text. deli'ler ing conceptual and factual frameworks on wh ich to hangdeeper and broader exploration of the field.Tothe latter end each chapter concludes with anannotated list of recommended further reading.Readers can check their progre ss with selfassessment exercises following each chapter:I found this book attractive not only because ofthe painless w y It dea ls with highly com plextopics, but also because of the overall phi losophy behind it Even a book over 500 pages, suchas this. cannot supply th e ultimate on everyaspect of speech sciences. Most peop le Wll notneed or wan t such a degree of deta il and rgument anyw ay. Kent aims for and achieves acom pleteness suffiCient to impart understanding offrameworks , terms and iss ues, but does notleave readers not seeingthe wood for the trees .Neve rthe less he imparts a confidence atarmed with his ntro duction,one could ", 0 01) iOtackle theory and appl lcatlo l- of any of thethemes the book embra Ce>.NIck. Miller ;$ based in the Department o( Speffh.Umv ersrty ofNewcastJe-Upon-Tyne, NE I 7RU.

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    Speech &Language Therapy inPractice has acopy of React,courtesy qf PropellerMultimedia and BordersCommunity Health ServicesNHS Trust, for awinningsubscriber. React normally retailsfor 425 +VAT and is one ofthe most comprehensive and upto date interactiveprogrammes available forworking with dysphasics.To enter, simply state, using nomore than 30 words, why youshould win this software. Sendthis with your name (and, ifyouknow it, your subscribernumber) to Avril Nicoll, Speech&Language Therapy in Practice,FREEPOST SC02255,STONEHAVEN AB39 3ZL*ore-mail to [email protected] note the winner will alsobe required to review thesoftware or provide acasestudy based around it for theSummer 99 issue.*For readers outvvith the UK the

    < address is Lnwood Cottage, HighStreet, Drum/ithie,StonehavenAB393YZ.

    1014 SPEECH & LANGUAGE THERAPY IN

    er~ - - - ~ - J - -a new, interactive computer programme devel-Borders Community Health Services NHS Trust_YN\OOller M u ~ i m e d i a Ld for use by adults with dys-

    programme is also suitable for clients withAllWU."" I III.I'""", and delayed or disordered language

    the ~ n benefits of wo rking with an interactive multimedia prounderWindows 95. The programme is simple and intuitive to use,use ofvideo, audio and animtion and has acomprehensive system of

    There is acomp h ' ,in to the ro e enslVe sconng module buitfeedback to t ~ ~ a ~ : ~ whthlch gives instant, 'I bl WI more detailed- : ; ; . ~ \ - - - . . : ~ ~ a v ~ a / ~e t o ! . t h ~ e ~ ~ ' ~ __ I" feature allows tneAcustomlSI(I% elect s?eCWlc tasKS React will r

    tnera?lst to ? r ~ S e ( l a b l \ ( I % atnera?y top PCs Or I ~ n t o n most desk-flOm tne me(l 'I Go meet tne rUnmng VVJ gop computerssess\O(l to be t a d ~ r ~ f tne c\'le(lt. fitted with n OWs 95 Or 98s?eClllc (lee ~ - CD_ROsaMund card anddove.ds f a cribe to Speech &Lan guage Therapy in Practice and only one

    subscriber number.W i ~ k ~ ..;..M by the e d ~ o r onor before 31 st December 1998.I C I J ~ ~ therapist nominated by the editor will select the winningwho the entrants are.be notified by 6th January 1999.

    to Rrovide either a review of he software or a case studyit to &Language Therapy in Practice by 22nd March 1999.frorrJ ~ l I e r Multimedia, Uit I Hardengreen Industrial Estate,EskbankEH22 3NX tel. 0131 663 2334, http://www.propeller.netlreactReader OfferReader Of{E

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    APHASIA

    Using

    entatIona

    computers withA s part of the clinical caseload in Queen MargaretCollege's speech and language therapy clinic, peoplewith aphasia are seen for group therapy during the academic year. Typically the groups include men an dwomen in their mid-30s to mid-60s who have aphasia an d associated communication problems. Usually clients attend the groupafter the period of spontaneous recovery can be assumed to becomplete (mainly six months to three years) and, indeed, some areseveral years post-onset. Since 1996, clients here have been usingcomputer-based writing therapy to promote their sentence levelwritten - and spoken - output.

    ~ ~ ~ ~ ~ ! X ~ ~ : ~ ~ ~ ~ o ~ ~ J ? o ~ e p ~ ~ ~ e n W i t h spelling monitor which can provide auditory feedback throughsynthesised speech at the end of a letter, word, sentence or para

    " .... " ~ . - a can benefit from ~ . & A ' ~ teatmesdLinda Armstrong__wW , l h an evaluation

    graph so that the user can hear (repeatedly if required) as well assee their output. Co:Writer is an intelligent prediction programme which can be used in conjundion with Write:OutLoudor other word processing package. It has two useful functions inlexkal and grammatical prediction (ie word choice and sentenceconstruction) as well as being a spelling-aid. Its producers suggestthat it is helpful for people with language difficulties or physicallimitations. By inputting the first letter(s) of a word , Co:Writerwill predict what the target may be, based on its own vocabulary,the user's frequency an d recency of word use and British English

    people whohave aphasiaspelling (see figure 1 for an example). Users can select the targetfrom the list by typing the associated number. It also provides adegree of grammatical prediction, ego subject-verb agreement (seefigure 2 for an example). Together, the programmes can aid writtenexpression and provide a speech output for people with a variery oflevels of difficulry, from those with single word written productionto those able to write long passages of text.

    Such programmes wereoriginally designed to helppeople with physical disabilities, such as thoseresulting from cerebralpalsy, to reduce keystrokesthereby reducing physicaleffort an d resultant fatigueand decreasing messagetransmission time. They arenow used with other groupsof people, such as thosewith learning disabilities orlanguage delay an d as strategies to improve qualiry aswell as quantiry of writtenoutput. Both can be usedon Windows-based orMacintosh computers an dimportantly are available inBritish English.Kingand Hux (1995) examined the reduction in wordlevel selection an d spellingerrors made by their clientwith mild aphasia when heused Write: OutLoud at sixyears post-onset an d reporta significant change in wfltIng qualiry with the most striking

    change in his written output occurring immediately after introduction of the talking feature. In their review of word prompt programmes, Wood et al (1997) include Co:Writer. It rated \vellamong seven other such programmes evaluated.

    Variety ofaimsThe aims of the computer-based therapy are individual to the cl ientan d priorities for individuals will differ according to their ab ilities......... ....... . . ........ ... ..... ................. ... lomirllled Oliff .. .

    SPEECH & LANGUAGE THERAPY IN PRACflCE WINTER 1998 15

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    APHASIA

    +- continued from previous page .. ... ..... ..... ...... .... ...... ........... ...... ... ...... .and needs. Some of the common aims are: to assist the production of written sentences to provide combined visual and auditory feedback on appropriate use of function words in sentence context, by offering multiplechoice options using grammatical prediction and synthelic speechconfirmation of choices to provide visual feedback on correct spelling of words, byoffering multiple choice options using word prediction an d syntheticspeech confirmation or visual confirmation of choices to offer opportunities for the production of modelled spokenoutput at sentence level.

    QuietenvrronrnentneededInitially sessions were organised so that pairs of clients were withdrawn from group sessions to work in parallel with the programmes on the two computers available. Ultimately the plan was to provide a working environment such as that found in computer workshops, \"here a room has a number of computers and one member of staff to help with any problems. Very quickly it became evident that clients required the quiet environment provided in an individual session - synthesised speech output from the other computer was very distracting and clients required individual support as they were learning how to use the keyboard and the programmes. Sessions therefore became one-to-one, usuaJly 30 minutes in length throughout the two-hour group sessions in the two semesters of the academic year with a long break over the summer vacation, that is, approximately 30 sessions per annum. Materials used

    S ! . i D W ! f i H ' ; { ] ; ~SPEAKING FOR MYSELF E Communication, Speech & Reading Development - l -Speaking fo r Myse lf was deSIgned by Bob Blac k Development O ffice r fo r TheDown's Syndrome ASSOCIatIon in Devon and West CornwaJl with adV Ice fromGrll ian Bird at the Down Syndrome Educational Trust.Speaking for Myself is a CDROM designed to su ppor t eady languagedevelopment in maInstream and special educat ion. It provide; a bank o freso urce and eachlng programs to develop whole wond sight vocabulary.pro gressIng in sma ll steps to early sentence build ing and simple three wordstories- The pack Includes lots of extra nash cards and sto ries to prin o ut.JUst Itke t he examples pro vided. Eas y-to -us e me nu structure includes :

    Il lustrated Talking FirstWo rdFlash cards with op t onal Rh ebusand Mabton symbols (sUUs andvideos)Sim ple Talking StonesPutting two words togeth er toencoucage pnoductive languageand baSIC read ing . Us.Moving on to three >,vords

    Optional Makaton Signing support Placeme nt of objeC1:sBasiC skil ls exercises Li ste ning exe lcises'M iSSing Word ' nursery Ihymes Shape sort ing and mat chingNu mber games and activities Av a il able on 30 days approval

    For Wi ndows 11 /9 5/98 . Requi re s a 486 o r bette r processor. 8mb Ram( 16mb recommended ). 256 (or better) colour VGA, sound ca . CD-ROM.[4 5 e x.VAT. t:3 p & p. VISA/ACCESS. Please allow 28 days for del ive ry.

    TOPOLOGIKA SOFTWARE\Natef5ide House. FaJmouth Road

    PENRY . Cornwall TRIO aBE.1 0 I326 37777 1 fax 01326 376755""",I o p o l g k a . d e m o n t o . , " ,webhtrpJltopolgka.deman.co

    . . File Edll format Options fan1 Speech 4:21 om .1J 161.Unhtl,' l1 ,

    m 1 [ ; J ~ ~ @ J ~ ! } ) J ~ ~ 0 BThe man is eating hi s lunch. I

    Ico :U)rlter Sample Writer ~,.He has some spa1: spaces2: spacy3: spaghetti4: spacing

    Figure 1 - Prediction (Co:Writer )varied according to clients' ability bu t consisted mainly of actionpictures an d compos.ite pictures to elicit sentences or paragraphs.For some, composing a diary became the focus. A hierarchy is evident here in which clients usually began their computer sessionsusing the action pictures as a stimulus from which to produce sen tences. Some remained at this level whilst others developed theirskills to the more abstract and challenging task of creating diaryentries . Composite pictures presented an intermediate degree ofdiffICulty where t.he client still had an external stimulus bu t hadmore choice in what to write.The examples from four typical clients in figure 3 show how thetwo programmes can improve the quantity and quality of writtenoutput. For CR and JM, pre- an d post-intervention assessments areshown using 'cookie theft' picture (Goodglass and Kaplan, 1983)and action picture descriptions respectively. Some quite dramaticexamples of change in written output occurred. However this typeof intervention is no t wit.hout problems for the current age-cohortof clients with acquired aphasia. Problems include:l.unfamiliarity with the QWERTY keyboard2.unfamiliarity with computers3.remembering to check the screen for options4.the need to be able to access the first letter5.slow output (eg. typically three sentences written per 30 minutesession)6.over-learning and overuse of particular structures after accessingan initial function word7.generalisalion (o f the clients only JM had a computer with theprogrammes installed at horne an d rep o rted using the programmesfunctionally) .On the other side, many benefits were evident , including:l.increased client confidence which led to Illore wi .llingness toattempt written output2.increased self-esteem through the feedback of the permanentcomputer print-alit of clients' written output, which looks muchmo re 'adult ' than the hand-writing of many clients with acquiredaphasia wh o have to use either their non-dominant hand to write,or write with a weak or spastic dominant hand3.increased self-esteem also through the visual evidence of theirachievement in learning an d using the programmes4.although this type of therapy proved labour-intensive, in thatonly two of the clients developed independent skill with t.he programmes, it can also be considered time-effective as spoken production and written expression can be targeted together.GeneralisationThis type of intervention has both advantages and shortcomings. Whilst there is no doubt that, for some people with agrammatictype problems, the programmes can improve written output, progress is slow and labour-intensive for both the therapist and the

    . client. For the current clinical population of people with aphasia, effort initially has to be devoted to becoming familiar with the technology before any intervention for language can be attempted. For the next generation this effort should not be required. They

    16 SPEECH & LANCUACETHERAPY IN PRACTICE WINTER 1998

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    . . rile Edi1 ronnel Opllons ront Speech 4:32 pm '" li!!ltJnlitl('(I Im J ~ ~ ~ G ! J ~ ~ ! ) j ] E E ~ 0 BThe man is eating hi s lunch.

    Co:Writer Sample Writer,.He

    1: is2: was3: has4' and

    FIgure 3 - examples from four clientsClient 1 PWWordprocessed without a boy is ir. (7 minutes) ('A help of therapist or the man is ironing') programmes: lady wo (5 minutes) ('A ladv was bakino a cake'i Next session - a week later The lady is knitting a sweater.with the programmes and The lady is smelling the flowers.some the rapist support:One year later - with the Today my daughter-in-law programmes and very little and my son came to visit me.therapist support: They came to have their teawith us. They brought somethings with them.

    Client 2 - CRWord-processed descr iption The woman is dishes, tap is of the 'cookie theft' picture overflow and water a own (Goodglass and Kaplan, 1983) fl oors. The two children top without help of therapist or cookie fall off the stool. the prOClrammes: Next session - a week later The man is playing cards. action picture description The woman is eating a roll, with the programmes and lettuce and tomatoes. some therapist support: The man is writing a letter to afriend.The woman is writing on a

    It y ~ w r i t e r but she has gloves on.Seven months later, the The woman is washing the 'cookie theft' picture dishes and the sink is over-description using the flowing. The water is flowingprogrammes independently: down onto the floor. Thechildren Are playing with thecookie jar and On top of thestool and the boy is falling off.Client 3 - JMWord-processed action picture The chiznie is the iron the description without help of ironstichs ('The Chinese mantherapist or the programmes: is ironing (on) the ironingboard')The woman is bineggs thedinck. ('The woman is breaking egCls (into) the ?bowl')Next session - a week later THE MAN IS KICKING THE with the programmes and BALL. some therapist support: THE MAN IS DRINKING HIS BEER. THE WOMAN IS RIDING A HORSE. THE MAN IS PICKING UP THE PARCEL. Four months later with the The man is ironing on a ironedprogrammes and minimal board. therapist support: The woman is making a cake.

    Client 4 HC

    Figure 2 - Grammatical prediction (Co:Writer )

    will also probably have more computer literate family suppon, As ever with speech an d language therapy intervention, generalisation of benefi t is the long-term goaL which can only be achieved when dients have the technology at home, On e of the clients who achieved most success with the programmes had both a computer at home with the programmes installed and a daughter who was able to help if needed, With the general increase in use of computers, an interesting new dilemma is emerging for speech and language therapists, If a client is given a low tech letter board, should it have an alphabetic or the QWER1Y layout?

    References Goodglass, H, and Kaplan E, (1983) Boston Diagnostic Aphasia Examination, Philadelphia: Lea and Febiger. King, J,M, and Hux, K. (1995) Intervention using talking word processing software: an aphasia case study. Me 11, 187-192, Wood, L.A., Rankin, J.L. and Beukelman, D .R. (1997) Word prompt programmes: current uses an d future possibilities, American Journal of Speech-Language Pathology 6,57-65,

    ResourcesWrite:OutLoud and Co:Writer are available from Don JohnstonSpecial Needs, teL 01925 241642,AcknowledgementMuch of the therapy with individual clients was carried ou t bysupervised third year undergraduate speech and language therapystudents.Alison MacDonald and Linda AnnslTong are based in the Department ofSpeech and Language Sciences, Queen Margaret College, Edinburgh.

    Word-processed without granny in daughter houseCo:writerSame session, word- A granny is inprocessed with Co:writer her daughter'S house.

    Questions ~ A n s w e r s What i6 the advantage of ogether, the6e programme6 provide word proce66ing,1J6il1g Co :Writer ' and 6pelling check6, auditory output and prediction of word6Write:OutLoud c together? , nd grammar.

    Why i6 group computer Programme6 with auditory output are di6tracting for ba6ed therapy not M M o t h . e r client6 and one-to-one 6upport i6 needed in a quietrecom mended? environment.How will computer-ba6ed The next generation of client6 will be more familiar with therapy become more .__ ~ c o m p u t e r 6 and the QWERTY layout, will be able to carry

    valuable? on u6ing the p,rogramme6 at home and will have moreinformed family 6upport.

    SPEECH & lANGUAGE THERAPY IN PRACTICE WINTER 19 98 17

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    REVIEWS

    ExceDentoverviewChildren LearningLanguage - A PracticalIntroduction toCommunicationImpairmentRita Narmore and RobertHopperSingularISBN 1-56593-856-925.00

    This American book providesan exce llent overview of language development and thedevelopment of communication and literac y.It is primarily written for teachers to learn how to developchi ldren's language in the classroom.It provides information on preverbal development the development of phono logy, semantics, syntax, pragmatics, literacyand the inter-re lation of language and cognition. Languagediversity, ie 'linguistically different children: is a good chapter.The book is a slim volume at208 pages but covers each section well, using recent research.Their main theme is that children learn language by be ing ina variety of language situations,for example, refusing some thing, asking permission . Eachcatego ry of commun ication hassuggestions about how to teachitThere is one short chapter onspeech and language disorders.They state that the rapy shoulduse more realistic communication srtuatlo ns. The y say thattraining in general cogniti vetasks, for example, solving puzzles , may sharpen children'slearning strategies to the pointthat they learn to communicateand that children should be ledinto interpersonal encountersin which language and communication skills can be used toaccomplish goals for the chil dren. If only it was so simplelThe authors refer to recentresearch which isof use to newtherapists and for more experienced therapists in backing upobservations and to give newinsights Into one's work. I high lyrecommend it for the excellence of the overview chapters.Connne Garvie is a pr ivatespeech and language therapist inCambridge.

    More pieces oftheptizzleClinical Phonetics andlinguistiCSEd. Wolfram Ziegler &Karin DegerWhurrISBN I 86/ 56 054 0

    3500This book is a collection ofresearch paperspresented atan International Cl inicalPhonet ics and LinguisticsConference in 1996. As such,rt covers a diverse range oftopics from th ese fields withre levance to both paediatncand adu lt speech and language therapy. The topicbased layout allow s the reader to concentrate on specifiCareas of interest while dipping Into other related sections. Some topics provide auseful overview of the current literature .To get the most out of thisbook and to understand thedetail of the research and rtsrelevance to current thinking,a working knowledge of language models would be beneficial. However, w ith lessknowledge , here isstill muchto be learned .Tho se lookingpure ly for direct po inters totherapy will not find many ofthem here. What the y willgain are a few more piecesto the jigsaw puzzle of language understanding and thebenefit of a wide range ofclient studies .This book could be a usefuladdition to a speech and language therapy departmentlibrary, particularly wheretherapists are un de rtakingresearch or case study vork.Its value is in providing awide ranging resou rce wrththe potential transfe r of ideasacross the fields as well as into the clinic. For me, rt provided a further insight intothe awareness thatresearchers are gaining ofthe complexity of communication and rts encoding, adeepened respect for thiscomplexity whi ch, as clinicians,we deal with on a dailybasis and rt sent me awayinspired to broaden my ownund erstanding.Tiffany Birch is a speech andlanguage therapist in London.

    IAdifferent perspectiveCoping With Aphasia Jon G Lyon Singular

    ISBN 1-879/05- 75-6 [ 3100Jon Lyon has spent more than thi rtyyears working in both research and clinical settings. He ispassionate about sharing insights into ways n which life can belived normally, despite the pre sence ofaphasia.This is therefore a practical bookaimed at supporting aphasics and theirfam ilies. It doe snot as sume that rts readers are fami liar with speech and languageimpairment and contains Jargon -freeinformation and advice. It also providesclinicians with a perspective other thanthat found In classic aphasia texts.The book is divided into four ma in sections. The first section describes whataphasia is and is not Lyon also spendstime providing the reader w ith anoverv iew of the rest of the bo ok.Section two is wrrtten as a 'journey';from onset of aphasia and initial hospita lisation, through rehabilitation to lifesevera l years on . My feeling is that Lyonoverdid the metaphor of a 'Journey' .Within this section key points are highlighted and boxed and are wrrtten fromthe perspect ive o f the caregiver or theperson with aphasia. For Instance, In thechapter about leaving care and goinghome. Lyon has Identified severa l worries that the aphasic might have. He thenmakes suggestions as to what the caregiver might wa nt to say or do inresponse to su ch worries. Section threeconsists of conc ise and readable explanations of speech, language and communication and the changes that can occurfollowing aphas ia. It also includesdescriptions of causes of aphasia andhow to reduce further risk.The last section contains a selectio n of personal stories . Each of hese deSCrIbes how othershave risen to the challenge of living wrthaphasia. The appendices which mainlyprov ide advice and addresses of whereto look for help are less helpful for thosenot resdent in the USA However, theydo Include a useful 'glossary of terms '.Overa ll I feel the boo k provides insightsof particular interest to newly qualifiedclinicians. Cl inicians responsible for providing training to volunteer groups or toother health profeSSionals may alsoenjoy dipping into it Unfortunately I amnot sure this is a book I would recommend to patients or their families.A lthough it is almost entirely Jargon-freeand full of usefu l information I wasuncomfortable with Its tone whichseemed patronising.Mar y- Lou Pevolin is a speech and languagetherapist wi Pymouth Community NHSTrust work.ing n a Strok.e t a ~ o n Unit

    Useful for everydepartment A Coursebook on Scientificand Professional Writing forSpeech-Language Pathology(2nd ed.)ME HegdeSngularISBN /-56593-868-2 [3/00This American coursebook, a

    lengthy, spiral-bound tome of 424pages, is presented as a pract icalteaching tool and resource manual.The main body of the book consists of exemplars and exerciseseach heralded by a detailed andpedantic heading in the contentspage (eg. AI.l I. Join IndependentClauses W rth a Semicolon Whenthe Clauses Are Not Jo ined by aCo njunction; B.3.3I . Cite BothNames in the Text When a WorkHasTwo Auth ors). Indeed, the fivecontents pages are presented insuch a manner as to constitute apocket -guide all by themselvesThe book is divided into parts A Band CAt he back s a usefulglossaryof terms and a small bibliograph y.Part A is designed to teach thebasic ski lls of good wrrt ing and covers composrtion, grammar and auseful section on commonly misused wo rds such as Incidence andPrevalence .Part B teaches scientifiC writingskills and focuses on accurate andappropriate presentat ion of papersfor publication. This specifiC style ofwriting is also required for researchor bursary applications. Topicsaddre ssed include the correct citation of references and the acceptable format for papers.Part C offers information andexamp les of formal. well-constructed professional reports such asreferral letters and comprehensivetreatment plans.Professional wnting skills are a must,not just for students or thoseengaged in research. Audrt is nowhigh on the agenda as is commun icating with purchasers and colleaguesin health and education and our wrrtten commun ications should be of thehighest standard. Dr Hegde's book ISa usefu l tool for every department.This is not an elegant book. but neither is it fr ightening. Easily digestib leand cleverly laid out, it will serve asa rererence work for the experienced to dip into and as a confidence builder for those consider ingwriting an article.Kate Padfield, speech and languagetherapist

    18 SPEECH & LANGUAGE THERAPY IN PRACTI CE WINTER 1998

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    May be useful for parentsChild Language Development Learning to TalkSondra Bochner, Penny Price, Jane JonesWhurrISBN I 861560400[19.50This book is based on the interactionalmodel of language development andthe language programme described inthe book was developed in Australia.

    Part I gives the background to the languageprogramme, with an overvie'll of theories oflanguage development and developmentalstages of language development Of moreuse, particularly to those unfamiliar withinteractional models, are chapters 3 and 4which nefer to contexts for learning: routineevents and play, and talking to childnen.Part 2 contains the main detail of the programme. Chapter 5 gives an overview ofhow to set up a language programme, whilstchapters 6 to 10 detail the five programmelevels: preliminary skills Uoint attention; turntaking; imitation; play); pre-verbal skills (protowords); first words; early sentences andcommunicative intentions.Part 3 explores the Issues of phonologicaldevelopment, signing as a stepping stone tospeech, working with childnen within groupsettings, such as playgroups or pre-schoolunits, and finally an early language modelsupport project is described.The authors state that the book has beenwritten for any professional working withlanguage-delayed childnen and that it mayalso be useful for parents. Certainly, it is nelatively Jargon-free and it would be possibleto work with a parent through Part 2 of thebook. Howevec the content and activitieswill alneady be familiar to most experiencedpaediatric speech and language therapists.The auih ors suggest that the programmecan be Impl emented with any child havingexpnes sive language difficulties, includingthose "with learning disabilities, developmental delay or Intellectual impairment" It is ashame that more detail and discussion as tothe progress of diffe rent sub-types of children could not be included and that evaluative data of programme impact was limitedto before and after language scores of thirteen children completing the programme.A large proportion of this book (at 44pages, almost a fifth) IS given to resourcerl}aterlals In the form of an append ix. It isunfortunate that these are not cop yrightfree, especially as some of his material couldbe very usefully employed with parents.In spite of this, Child Language Development: Learning to Talk would be a useful andvery readable addition to departmentallibraries.

    Practical ideas lackingEarly Intervention for SpecialPopulations of Infants and ToddlersEd Louis Rosetti & Jock KileSingularISBN 1-56593-798-8[1995This book contains a compilation fromthe first seven years of he In(ant-ToddlerIn tervention: The Transdiscipilnary Journal.Some of the most pertinent articles,from auth ors in the USA and Canada

    have been selected for inclusion.The book is arranged around five keythemes. The ks t section addresses issuesarou nd the identification, assessment andmanagement of heari ng impairments. Thesecond looks at enhanc ing the overa ll performance of childnen with physical lim itations. Section three examines the effects ofpre-natal cocaine and drug exposure. Thefourth deals with tracheotomised childrenand the fifth provides information on thedevelopment of premature and low birthweight infants.The editors provide a brief introduction tothe papers at the start of the book but further commentary would ha