Brian Petheram

Using a computer to improve functional writing in a patient with severe dysgraphia

This case study describes and evaluates the therapy administered to MF to improve his severe writing impairment caused by a stroke eighteen months prior to this therapy intervention. Therapy was based on developing a compensatory strategy using his residual skills of being able to spell a word orally. A detailed account of the sequence of therapy procedures is given, initially focusing on specific non-functional tasks, followed by therapy with a more functional focus. A computer was used throughout the intervention to facilitate intensive repetitive practice. The intervention proved to be successful, both in terms of improvements on assessments and with evidence of functional benefits. The use of both a dictionary to support the strategy and an adaptive word processor to promote functional carryover is described. The role of the computer in therapy is discussed as a tool to facilitate repetitive practice of therapy and encourage the independent use of the strategy embodied in therapy.

Demographic and epidemiological analysis of patients referred to speech and language therapy at eleven centres 1987-95

This retrospective study analyses data collected on an information system developed specifically for the use of speech and language therapists and the management of their services. The age, gender, medical diagnoses, and speech and language therapy diagnoses associated with the referral of > 73,000 clients to 11 speech and language therapy providers between 1987 and 1995 are reviewed. In 1987, 34.8% of the patients referred to speech and language therapy did not have a formal medical diagnosis and this was commonly associated with children with speech and language delay or disorders. However, by 1995, the group not having a formal medical diagnosis had fallen to 17.2% of referrals. Whereas in 1987, 22.7% of the referrals with a medical diagnosis to speech and language therapy were associated with stroke, this has increased in 1995 to 32.0%. Dysphagia represented 0.94% of the referrals in 1987 but 20.6% of referrals in 1995. The gender balance of referrals has remained remarkably constant over the period of study: 60% of referrals were male and 40% female. Whilst nearly half of all referrals were aged under 5 years, the proportion of all referrals represented by this age group has fallen slightly over these years. This has been matched by an increase in the proportion of the caseload aged over 70.

Has aphasia therapy been swallowed up

Objective: To review the change in number of referrals to speech and language therapy for dysphasia and dysphagia over one decade. Design: This retrospective study analyses data collected on an information system developed speci cally for the use of speech and language therapists in the management of their services. Setting: Eleven health care providers used the system between 1985 and 1995 and recorded details of 73 758 patients referred to speech and language therapy during that period. Results: Whilst there were 12 times as many dysphasic patients as dysphagic patients referred to speech and language therapy in 1987, the position was reversed by 1995 with twice as many dysphagic as dysphasic patients being referred to these services. Dysphagia in 1987 accounted for less than 1% of the referrals to speech and language therapy. This percentage increased, until in 1995 20% of referrals were for dysphagia. Conclusion: No causal relationship between the changes in referral to speech and language therapy for these two groups has been established in this study. However, there has been a signi cant increase in referral to speech and language therapy of people with dysphagia. Whilst referrals for dysphasia have increased, they represent a lower percentage increase and now receive less treatment per case than in 1987.

‘Pick me up and not a down down, up up’: how are the identities of people with aphasia represented in aphasia, stroke and disability websites?

Suddenly acquiring a permanent impairment means a person must learn to think differently (Frank, 1995), and he or she does so partly by telling stories. The most commonly told illness narratives are ‘restitution’ narratives. People with aphasia (a communication impairment commonly following stroke) surfed aphasia, stroke and disability websites, read the personal stories attached to them, and created their own narratives in response. Charitable and disability‐related websites excluded people with aphasia through their tone, content and narrative ‘voice.’ Engagement with some websites was contingent on subscribing to a specific perspective on aphasia. Personal narratives attached to charitable websites were seen to reflect the organisational stance. In particular, idiosyncracies of aphasic language were often eliminated. When participants constructed their own web pages they replicated the stylistic traits that had previously been criticised. Identities are mercurial and difficult to pinpoint. Further work with people with aphasia using videoclips, soundclips and other non‐text‐based techniques to create illness narratives is planned.

An analysis of referrals to speech and language therapy in 11 centres, 1987-95.

This retrospective study analyses data collected on an information system developed specifically for the use of speech and language therapists in the management of their services. Eleven healthcare providers have used the system since 1985. This paper reflects data on 73,000 clients referred to these speech and language therapy services between 1987 and 1995. The annual referral rate to these 11 trusts in 1987 was 4129, rising to 11,944 in 1995. The percentage referrals per head of population per year varies between 0.32 and 0.58% of the population. Of referrals to speech and language therapy, 96% comes from 24 different sources, including self referrals and referrals from other agencies, such as education. The top five referrers in 1987 were health visitors, educational service, general medicine/geriatrics, general practitioners (GPs), and other speech and language therapists. In 1995 ear, nose and throat (ENT) services replaced speech and language therapists in the top five referrers.

Using benchmarking data for assessing performance in occupational therapy

Comparing outcome data derived from patients receiving treatment in different sites can identify different practice worthy of further examination. This paper illustrates an approach to benchmarking with data collected on 1,711 patients who have received occupational therapy in nine healthcare trusts. Detailed results of 288 patients indicate that there were differences between the services in the patients referred for occupational therapy, they were discharged at different points in their recovery and different amounts of gain were achieved during the treatment period. In order to interpret the reasons for the variation meaning needs to be added to the data. While casemix is an important consideration and may account for many of these differences, it would also appear that investigation of the different processes of care in different trusts may warrant further study.

Benchmarking Can Facilitate the Sharing of Information on Outcomes of Care

Recent restructuring in the national health service (NHS) aimed to effect cultural and organisation changes that would ensure fair and equal access for service users to effective and efficient services. Clinical governance has been introduced as a means of delivering quality improvement. One element of this is the use of benchmarking to assess current process and outcome and to use comparative information to inform about current and best practice. The use of the Therapy Outcome Measure (TOM) (Enderby and John 1997) was investigated as an indicator to benchmark the outcomes of treatment for different client-groups and compare patterns of outcomes from different speech and language therapy (SLT) services. The study recruited eight SLT trust sites and ran for eighteen months. The TOM data was analysed to note similarities and differences in cases entering treatment, in the direction of change resulting from treatment, and on completing treatment. Variation was found on these points between cases with different disorders and across the trusts. TOM data could be used to provide a benchmark for a disorder against which services could make comparisons. However, for benchmarking to succeed there is a need for support and commitment from every level of an organisation.

A survey of therapists' attitudes to computers in the home-based treatment of adult aphasics

Abstract In order to enable a wide cross-section of practising speech therapists to have an influence on the design of a computer-based therapy system that the author is developing, a questionnaire was compiled and distributed. Questions addressed two main areas: current practice in the setting of homework (the results of which are being published separately) and requirements and concerns arising from the potential application of computers to this area of therapy, the results of which form the basis of this paper. Of 1220 questionnaires that were distributed, 572 were completed and returned. Responses reported here result from questions on: the amount of use a therapist might make of such a system; the relative importance of various possible features; the significance of potential benefits; and the nature of any problems that might arise. Results are presented in tabular form and it is argued that they highlight issues which need to be addressed if computers are to be widely adopted, as well as offering e...

Self-administered therapy at home for aphasic patients

Abstract This paper will address the current practice of speech therapists setting homework for aphasic patients.

Microcomputers as a supplement to aphasia therapy

Abstract This paper reports on a microcomputer system developed for use by aphasie stroke victims in their homes independently of therapist supervision. The system was installed in the homes of 10 patients for a period of 6 weeks. The system recorded data on usage and performance, and standard aphasia assessments were administered before and after each installation. All patients made substantial use of the system and no difficulties in controlling or understanding the system were reported. Results captured by the system software showed some evidence of improved performance, but this was not reflected in the standard aphasia assessments which showed no overall pattern of change. The amount of improvement varied widely between patients.