Teaching and learning speech and language therapy skills: the effectiveness of classroom as clinic in speech and language therapy student education.

BACKGROUND: Terms such as 'clinical intuition' have often been applied to the practice of speech and language therapy. Various authors have aimed to make the process of therapy practice more explicit, and it is argued that recently developed descriptive/analytic frameworks have the potential to engender the critical mindset necessary for student speech and language therapists to become good reflective practitioners, with the potential for enhancing clinical education. AIMS: To investigate whether and how aspects of clinical skills education could be usefully addressed in an academic, as opposed to a clinical, setting. The study aimed to address the question of whether use of an interaction analysis system, in conjunction with video observation, and 'practice simulation' in a teaching-learning programme could be shown to have a positive impact on: (1) students' perceptions of their own understanding and practice of therapy, and their perceptions of themselves as self-reflective practitioners; and whether (2) this was borne out by students' ability to observe and interpret therapeutic interaction, as measured by (i) an objective written assessment; (ii) an objective video observation assessment; and (iii) assessment of their abilities in clinical practice. METHODS & PROCEDURES: Thirty-six students from City University took part in an experimental, placebo-controlled study using a deferred intervention design. Assessments designed to reflect changes resulting from the teaching-learning curriculum were carried out pre- and post-intervention with experimental and control groups. Quantitative and qualitative results were obtained. OUTCOMES & RESULTS: The intervention programme was found to have had a significant impact on students' perceptions of their understanding of therapy, but not on their perceptions of their practice of therapy. The experimental group scored significantly better on a written assessment of 'interpretation of therapy interaction', but were no better than the control group on a 'Video observation' assessment. Owing to attrition and the poor quality of videos submitted for assessment, it was not possible to measure changes in actual clinical practice. Qualitative feedback from the teaching-learning programme suggests that students generally found the approach to be beneficial. CONCLUSIONS: While there were some encouraging results, it is still uncertain whether addressing the actual practice of therapy in an academic setting gives 'added value' to the work carried out on clinical placements. However, there is no doubt that bringing this type of programme under the umbrella of an academic institution would greatly increase the consistency of teaching and the range of experiences available to students.

Measuring quality of life in people with aphasia: the Stroke Specific Quality of Life Scale.

Assessing health related quality of life (HRQOL) in people with communication disabilities is a challenge in health related research. Materials used to assess HRQOL are often linguistically complex and their mode of administration usually does not facilitate people with communication disabilities to give their experiences. We are currently running a medium scale study (80 participants) which aims to explore the HRQOL of people with long-term aphasia and to assess the psychometric properties and the acceptability of the Stroke Specific Quality of Life Scale (SS-QOL) (Williams et al. 1999) as a single measure for the assessment of HRQOL in this population. Here the initial stages of modifying the SS-QOL for use with people with aphasia will be presented. We will concentrate on the process of making the scale communicatively accessible to people with aphasia and increasing its content validity with this population group.

Examining interaction in language therapy.

Discussions around a 'theory of therapy' have prompted attempts to delineate the components of therapy for language impairment in aphasia. Here it is suggested that the therapy components associated with how language therapy is enacted need more precise specification, especially in relation to what is entailed by interaction between therapist and person with aphasia. Presented too is a system used for the analysis of interaction in language impairment therapy for aphasia and its possible applications are discussed. Components of the system are described and a sample analysis presented. The methodological difficulties entailed in making comparisons of therapy enactment are discussed. It is suggested furthermore that unless more is known about precisely defined interactions in therapy, it will be difficult to answer basic questions not only about how language therapy is being carried out, but also, subsequently, whether the ways in which therapy tasks are enacted have a significant impact on the outcome.

Drawing together: evaluation of a therapy programme for severe aphasia.

This paper reports a therapy study that aims to promote communicative drawing in a group of seven people with severe and long-standing aphasia. Therapy was conducted on individual and group bases over 12 weeks and entailed a range of techniques which are described in some detail. Treatment was evaluated using a novel generative drawing assessment in which subjects were required to draw absent items in response to photographic and conversational cues. Pre- and post-therapy assessments of untreated skills, such as comprehension, naming and gesture, were also conducted. The results indicated that, as a group, the subjects' drawing improved. Unchanged performance on the other assessments indicated that the gains were specific to the content of therapy and could not be attributed to spontaneous recovery. Pre- and post-therapy interviews with carers (i.e. relatives and close friends of the individuals) suggested that the effects of therapy were also being felt in the home. These results have important implications for therapy with people with severe aphasia.

What makes a therapy? Some parameters of therapeutic intervention in aphasia.

It has often been assumed that detailed analyses of aphasic impairments would be both necessary and sufficient for the development of remediation programmes. In this paper, we argue that the analysis of the impairment is a necessary but not sufficient precondition for therapy. Adequate remediation programmes require the development of an independent theory of therapy that provides a detailed specification of the different components of the therapeutic process. Therapy can be shown to have as many interacting components as the impairment itself. In this paper, we try to identify some of the components of the therapy process by comparing different therapy programmes that have been employed in the remediation of 'mapping deficits' in agrammatism.

Sentence processing deficits: a replication of therapy.

This paper describes the replication of a therapeutic programme originally used by one of the authors, Byng (Cognitive Neuropsychology, 1988, 5, 629-676) to remediate a specific sentence processing deficit. Our patient is shown to have similar although not identical deficits to those of one of the patients (JG) described in that programme. Sentence comprehension and production both improved as a result of therapy. The pattern of results observed gave further insights into both the nature of the patient's deficit and the mechanism of therapy.