Developing communication skills in deaf primary school pupils: Introducing and evaluating the smiLE approach

Many profoundly deaf signers have difficulty communicating with hearing people. This article describes a therapy called ‘Strategies and Measurable Interaction in Live English’ (smiLE; Schamroth and Threadgill, 2007a), an approach used to teach deaf children skills to become successful communicators in real-life situations. This study evaluates the effectiveness of smiLE in helping deaf pupils develop their ability to make successful requests in a specific communication situation and whether this generalized to another communication situation. Sixteen severely and profoundly deaf primary school pupils (7.2—11.0 years old) received an 11-week programme of therapy. Their performances in a trained and an untrained communication situation were compared pre- and post-therapy. In the trained task, the pupils’ interactions improved significantly. No differences were found in the untrained task, suggesting that the learnt skills did not generalize. Anecdotal findings suggest that some carry-over into a similar situation had occurred and that trained skills were maintained. The smiLE therapy approach is effective in providing deaf children with the communication skills and confidence to interact with English speakers in targeted situations. The lack of generalization of these skills to similar situations may be overcome by a longer therapy programme that specifically promote these skills across different situations

Psychological characteristics of children with visual impairments: learning, memory and imagery

The performance of children (and sometimes adults) with visual impairments (VI) on a range of tasks that reflect learning, memory and mental imagery is considered in this article. Sometimes the evidence suggests that there are impairments in performance in comparison with typically developing children with vision and sometimes some advantages emerge. The author’s aim is to describe some of her own and others’ findings and explore what they tell us about the cognitive characteristics of such children, so that progress with practical interventions can be advanced through understanding. The article starts by focusing on social-cognitive development and in particular considers the potential benefits of language in that development. This is followed by a review of some studies of learning and memory performance which provide a coherent picture of development without vision and finally ends with a consideration of spatial mental imagery

Children with phonological problems: a survey of clinical practice

Background: Children with phonological problems are a significant proportion of many therapists' caseloads. However, little is known about current clinical practice with these children or whether research on the effects of therapy have influenced this practice. Aims: To investigate the methods of assessment and remediation used by therapists working in the UK. Methods & Procedures: A questionnaire was sent to therapists working with pre- and primary school-aged children. Outcomes & Results: Ninety-eight clinicians of varying experience responded. Most used the South Tyneside Assessment of Phonology to assess children, were confident in choosing therapy, and were aware of evidence that therapy is beneficial. They used a variety of therapies. Auditory discrimination, minimal contrast therapy, and phonological awareness were popular and often used in combination. Most involved parents. In planning therapy, clinicians were more influenced by children's language and cognitive abilities and the motivation of parents than by the nature of the impairment. Conclusions: Constraints upon clinicians make it difficult for them to convert research findings to practice. In particular, assessments that allow more individualized and targeted interventions appear little used. Clinicians are aware of research but there is a danger that clinical practice and research are diverging

Evaluating the effectiveness of therapy based around Shape Coding to develop the use of regular past tense morphemes in two children with language impairments

It has been suggested that difficulties with tense and agreement marking are a core feature of language impairment. Hence, studies are required that analyse the effectiveness of intervention in this area, including consideration of whether changes seen in therapy sessions generalize to spontaneous speech. This study assessed the effectiveness of therapy based around Shape Coding in developing the use of the regular past tense morpheme -ed in two school-aged children with language impairments. It also considered whether participants benefited from additional generalization therapy in order to start using target forms in their spontaneous speech. The former was assessed using a sentence completion task and the latter by a conversational task with blind assessors. One participant improved markedly in sentence completion but did not gain in the conversation task until after the generalization therapy. The other made more modest gains on the sentence completion task and seemed to generalize to the conversation task without recourse to the generalization therapy. Larger studies are required to confirm these interpretations and to determine whether they are applicable to the wider population of children with language impairments

"Like déjà vu all over again": Patterns of perseveration in two people with jargon aphasia

Background: It has been argued that perseveration type corresponds to the level of breakdown so that total perseveration (the repetition of a whole word) involves the reactivation of a previous word at the lexical level when the target word is not sufficiently activated. A blended perseveration (the repetition of part of a previous response) results from a failure of target activation at the phoneme level (e.g. Martin & Dell 2007). This is challenged by the occurrence of non-word total perseverations, as these cannot be lexical retrievals (Hirsh 1998). A further problem is the occurrence of long intervals between perseverations and their sources. Some authors have invoked semantic relationships to explain these intervals (e.g. Martin, Roach, Brecher & Lowery 1998). Aims: This study examines the perseveration of two individuals with jargon aphasia in order to explore the proposal that while some perseveration may result from the reactivation of a recent response via the mechanisms described above, another mechanism exists whereby perseverative responses are built around default phonology, resulting in stereotypical errors. Methodology and Procedures: Tests of naming, reading and repetition were administered. Responses were analysed to determine: the extent of perseveration; the occurrence of long intervals between perseverations and their sources; patterns of phoneme use; the occurrence of non-word total perseverations. Outcomes and Results: Both individuals produced large numbers of perseverative responses. Lengthy intervals could not be explained by semantic relationships. For each participant, certain consonants were found to dominate the phoneme frequency distribution. Evidence was found of an interaction between the occurrence of perseveration and presence of these favoured consonants. The possibility that non-word total perseverations arose from a different source from word total perseverations was rejected because there was no significant difference in the use of the favoured phonemes between the two types. Conclusion: The findings support the theory of two mechanisms for perseveration. The first is local, occurring when residual activation overrides incoming activation. This is confined to a single speech act and occurs closely after the original occurrence. The second type is global, occurring across different contexts over time. It occurs because of default phonology, available in the event of a dearth of incoming activation at the phoneme level. Both total and blended perseverations may result from this mechanism. Word total perseverations may be favoured because of feedback from the phoneme level to the lexical level. Ideas for future research and implications for intervention are discussed

Delivering the Lee Silverman Voice Treatment (LSVT) by web camera: a feasibility study

Background: Speech disorders are a feature of Parkinson's disease, typically worsening as the disease progresses. The Lee Silverman Voice Treatment (LSVT) was developed to address these difficulties. It targets vocal loudness as a means of increasing vocal effort and improving coordination across the subsystems of speech. Aims: Currently LSVT is not widely available, and there are practical difficulties associated with the delivery of an intensive treatment in an environment of resource constraints in the National Health Service (NHS). Delivery of LSVT over the World-Wide Web may address some of these difficulties. Methods & Procedures: A feasibility study is reported in which three individuals with speech disorders resulting from Parkinson's disease received LSVT over the Internet, using broadband connection and a web camera. Participants were seen face to face for every fourth session in order to build a personal relationship, measure vocal sound pressure level (SPL) during treatment, and to review and prepare homework tasks. All other sessions were delivered over the Internet. Outcomes & Results: Broadly similar treatment gains were found between individuals treated over the Internet and those treated face to face. Gains were maintained or improved at an assessment two months after the treatment. Conclusions & Implications: This study demonstrates that delivery of LSVT over the Internet is feasible, and that a larger trial would be appropriate to establish cost and treatment effectiveness

Effectiveness of vocabulary intervention for older children with (developmental) language disorder

BACKGROUND: Children with developmental language disorder (DLD) frequently have difficulties with word learning and understanding vocabulary. For these children, this can significantly impact on social interactions, daily activities and academic progress. Although there is literature providing a rationale for targeting word learning in such children, there is little evidence for the effectiveness of specific interventions in this area for children with identified DLD. AIMS: To establish whether direct one-to-one intervention for children with DLD over 9 years of age leads to improved abilities to identify, comprehend, define, and use nouns and verbs targeted in intervention as compared with non-targeted control items and whether or not the participants’ rating of their own knowledge of the words changes with intervention. METHODS & PROCEDURES: Twenty-five children and young people with language disorder (aged 9;4–16;1) participated in the study: 18 with DLD and seven with a language disorder associated with autism spectrum disorder (ASD). Two assessments of different levels were created: a higher ability (less frequent words) and a lower ability (more frequent words). Participants’ speech and language therapists (SLTs) decided which level would be the most appropriate for each participant. Four tasks were carried out as part of the assessment and the scores were used to identify which words each participant worked on. Participants received one 30-min session per week one-to-one with their own SLT for 7 weeks, plus a 5-min revision session in between each main session. During each of the first five sessions, participants learned two new words; the two final sessions were spent revising the 10 words which had been targeted. OUTCOMES & RESULTS: Post-intervention assessment showed an increase in scores for both treated and control words. However, progress on treated words was significantly greater than on control words (d = 1.07), indicating effectiveness of intervention. The difference between progress on targeted and control words was found both for nouns (d = 1.29) and verbs (d = 0.64), but the effect size was larger for nouns. Whether or not the participants had an associated ASD did not affect the results. The children's self-rating of their knowledge of the targeted words was also significantly higher than for control words post-intervention. CONCLUSIONS & IMPLICATIONS: The intervention delivered one-to-one by the participants’ usual SLT was effective in teaching new vocabulary to older children with language disorders. This shows that older children with language disorders can make progress with direct one-to-one intervention focused on vocabulary

Accessibility of 3D Game Environments for People with Aphasia: An Exploratory Study

People with aphasia experience difficulties with all aspects of language and this can mean that their access to technology is substantially reduced. We report a study undertaken to investigate the issues that confront people with aphasia when interacting with technology, specifically 3D game environments. Five people with aphasia were observed and interviewed in twelve workshop sessions. We report the key themes that emerged from the study, such as the importance of direct mappings between users’ interactions and actions in a virtual environment. The results of the study provide some insight into the challenges, but also the opportunities, these mainstream technologies offer to people with aphasia. We discuss how these technologies could be more supportive and inclusive for people with language and communication difficulties

The working practices and clinical experiences of paediatric speech and language therapists: a national UK survey

Background: The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. Aims: To investigate the working practices and professional experiences of paediatric SLTs working in the UK through an online survey. Methods & Procedures: The survey was conducted online using Survey Monkey. Therapists were alerted to the survey through the Bulletin of the Royal College of Speech and Language Therapists and by e-mails to national special interest groups. Outcomes & Results: A total of 516 clinicians completed the survey. A large majority worked in the National Health Service (NHS). A varied pattern of working was revealed. Most worked in several settings and saw a range of clients. A typical clinician spends less than one-quarter of their time giving direct therapy and more than one-quarter training parents and other professionals. Nearly half of respondents felt that their time could be better used. Too little time for direct therapy and the time required for administration emerged as their principal concerns. Most clinicians have specialist knowledge of particular client groups and spend more time with them than do non-specialists. Nevertheless, clients are more likely to be treated by a therapist who does not claim to have specialist knowledge of their condition than by one who does. The only clients for whom this is not the case are those with dysphagia. Eighty per cent of respondents felt that proposed changes to the NHS would not benefit the children they treat and there was widespread concern about cuts and the effects of general practitioner commissioning. Despite this, a large majority expected to remain speech and language therapists 5 years from now. Conclusions & Implications : This survey provides an overview of the working practices of paediatric speech and language therapists. Its findings have significant implications for training and workforce development in the profession

Therapy for naming difficulties in bilingual aphasia: which language benefits?

Background: The majority of the world's population is bilingual. Yet, therapy studies involving bilingual people with aphasia are rare and have produced conflicting results. One recent study suggested that therapy can assist word retrieval in bilingual aphasia, with effects generalising to related words in the untreated language. However, this cross-linguistic generalisation only occurred into the person's stronger language (L1). While indicative, these findings were derived from just three participants, and only one received therapy in both languages. Aims: This study addressed the following questions. Do bilingual people with aphasia respond to naming therapy techniques developed for the monolingual population? Do languages respond differently to therapy and, if so, are gains influenced by language dominance? Does cross-linguistic generalisation occur and does this depend on the therapy approach? Is cross-linguistic generalisation more likely following treatment in L2 or L1? Methods & Procedures: The study involved five aphasic participants who were bilingual in English and Bengali. Testing showed that their severity and dominance patterns varied, so the study adopted a case series rather than a group design. Each person received two phases of naming therapy, one in Bengali and one in English. Each phase treated two groups of words with semantic and phonological tasks, respectively. The effects of therapy were measured with a picture-naming task involving both treated and untreated (control) items. This was administered in both languages on four occasions: two pre-therapy, one immediately post-therapy and one 4 weeks after therapy had ceased. Testing and therapy in Bengali was administered by bilingual co-workers. Outcomes & Results: Four of the five participants made significant gains from at least one episode of therapy. Benefits arose in both languages and from both semantic and phonological tasks. There were three instances of cross-linguistic generalisation, which occurred when items had been treated in the person's dominant language using semantic tasks. Conclusions & Implications: This study suggests that ‘typical’ naming treatments can be effective for some bilingual people with aphasia, with both L1 and L2 benefiting. It offers evidence of cross-linguistic generalisation, and suggests that this is most likely to arise from semantic therapy approaches. In contrast to some results in the academic literature, the direction of generalisation was from LI to L2. The theoretical implications of these findings are considered. Finally, the results support the use of bilingual co-workers in therapy delivery