Indirect language therapy for children with persistent language impairment in mainstream primary schools : outcomes from a cohort intervention

A manualized language therapy developed via a randomized controlled trial had proved efficacious in the short-term in developing expressive language for mainstream primary school children with persistent language impairment. This therapy had been delivered to a predetermined schedule by speech and language therapists or speech and language therapy assistants to children individually or in groups. However, this model of service delivery is no longer the most common model in UK schools, where indirect consultancy approaches with intervention delivered by school staff are often used. A cohort study was undertaken to investigate whether the therapy was equally efficacious when delivered to comparable children by school staff, rather than speech and language therapists or speech and language therapy assistants. Children in the cohort study were selected using the same criteria as in the randomized controlled trial, and the same manualized therapy was used, but delivered by mainstream school staff using a consultancy model common in the UK. Outcomes were compared with those of randomized controlled trial participants. The gains in expressive language measured in the randomized controlled trial were not replicated in the cohort study. Less language-learning activity was recorded than had been planned, and less than was delivered in the randomized controlled trial. Implications for 'consultancy' speech and language therapist service delivery models in mainstream schools are outlined

The voice of the text in selected prose works of Reinaldo Arenas

In approaching the voice of the text in the prose works of Reinaldo Arenas, I have selected seven texts for analysis: El mundo alucinante, the five novels which conform the Pentagoma quintet (Celestino antes del alba, El palacio de las blanqmsimas mofetas, Otra vez el mar, El color del verano, and El asalto), and Viaje a La Habana. Studies on Arenas's prose work to date have largely concentrated on parallels between Arenas's biography and aspects of his fiction, with emphasis on questions of fantasy and the carnivalesque. I explore the works from a purely textual perspective, taking as my theoretical framework the interplay between three approaches to the text; transtextuality (according to the theories proposed by Gerard Genette), narratology and focalization (Eduardo Serrano Orejuela and Mieke Bal). Through an examination of the structure and narrative voices in this body of prose works, I confront the symbolic and ideological voice of the text. A thematic function is evident behind the structural complexity of the works and the vertiginous reading experience created by the texts, along with the relationship the novels sustain with "history" and other external texts. My consideration of the voices which narrate the pieces and the perceptions through which events are depicted exposes close relationships between sections of the same text and between the prose works I explore. In turn, the characterisation of the narrators, heroes and protagonists of the works centres very acutely around the individual's Other, and reveals ideological and thematic implications that are consistent between the works. The treatment of these aspects in the seven texts engenders the reading process I describe as "vertigo"; it is through this process that the ideological notions regarding testimony and the subjectivity of history are revealed

Becoming a manual occupation? The construction of a research therapy manual for use with language impaired children in mainstream schools

The construction of therapy protocols for a large-scale randomized controlled trial comparing speech and language therapists and assistants, and group and individual therapy approaches for children aged 6-11 in mainstream schools is outlined. A search of the research and professional literature and of published therapy materials was conducted to locate usable examples of effective language therapy for primary school children. Results were collated into a manual of therapy principles and activities to structure research intervention. The use of the manual with children (n=30) receiving individual or group direct therapy from a speech and language therapist in the first phase of intervention was audited. Very few high-level research studies were found, but the professional literature gave added information. Therapies for comprehension monitoring, vocabulary development, later grammar and narrative were adapted for the research intervention, and procedures compiled into a manual to guide research speech and language therapists and assistants. The audit of direct therapy suggested that the manual was useable, providing a suitable range of activities and materials for therapy intervention. Its use helped to record the therapy offered to research children, and formed a sound basis for discussion amongst speech and language therapists and between speech and language therapist/assistant pairs. The construction and use of a therapy manual allowed the provision of replicable therapy within the research project whilst maintaining flexibility

Thinking for two: a case study of speech and language therapists working through assistants

Many speech and language therapists (SLTs) in the UK work with speech and language therapy assistants, and the numbers of SLT assistants is expected to grow. There has been very little empirical investigation of how SLTs feel about this situation or the effect on working practices of working indirectly. Although respondents could see value in working through assistants, they stressed the time required to do so and the difficulties of adapting and updating therapy plans when working indirectly

Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans

Previously, we reported that one individual who had a motor complete, but sensory incomplete spinal cord injury regained voluntary movement after 7 months of epidural stimulation and stand training. We presumed that the residual sensory pathways were critical in this recovery. However, we now report in three more individuals voluntary movement occurred with epidural stimulation immediately after implant even in two who were diagnosed with a motor and sensory complete lesion. We demonstrate that neuromodulating the spinal circuitry with epidural stimulation, enables completely paralysed individuals to process conceptual, auditory and visual input to regain relatively fine voluntary control of paralysed muscles. We show that neuromodulation of the sub-threshold motor state of excitability of the lumbosacral spinal networks was the key to recovery of intentional movement in four of four individuals diagnosed as having complete paralysis of the legs. We have uncovered a fundamentally new intervention strategy that can dramatically affect recovery of voluntary movement in individuals with complete paralysis even years after injury