Shelagh Brumfitt

Professional differences in interprofessional working

UK government policy is encouraging healthcare staff to blur traditional roles, in the drive to increase joint working between practitioners. However, there is currently a lack of clarity regarding the impact that changes to traditional working practice might have on staff delivering the services, or on patient care. In this article, we report findings from three qualitative case studies examining interprofessional practice in stroke care, in which the influence of professional differences emerged as a significant theme. We draw on findings from individual semi-structured interviews, as well as fieldwork observations, to describe the influence of professional knowledge and skills, role and identity, and power and status considerations in interprofessional working. The insights that were gained contribute to the understanding of how professional differences impact on healthcare staff joint working, and suggest that the elements identified need to be fully considered in drives towards changed working practice.

Losing your sense of self: What aphasia can do

Abstract As the knowledge base in aphasiology continues to expand, it is increasingly obvious that information about specific language processes does not enhance our understanding of the aphasics personal predicament. Although the aphasic literature is interspersed with occasional papers focusing on the personal impact of aphasia, the major emphasis continues to be on the linguistic and associated aspects. It has been argued that most treatments have two components (Brumfitt and Clarke 1983). I think this can be taken further, and would suggest that most clinical conditions have two components. One is the technical analysis (according to, say, the cognitive neuropsychological model) and the other is the personal impact of the condition. I would like to address the issue of the persons reaction to aphasia in an attempt to redress the balance between the predominant focus on technical aspects and the limited attention given to the person.

Evaluation of communication, life participation and psychological well‐being in chronic aphasia: The influence of group intervention

Background: The impact of change in communication, life participation, and psychological well‐being in aphasia is recognised but still not fully explored. Further, considerable scope exists to address these factors within the context of intervention. Innovative practices and group intervention are advocated for people with chronic aphasia but detail and evidence remains limited. We are grateful to Leeds Health Authority, the Leeds Speech and Language Therapy Service, Leeds Social Services, Leeds Metropolitan University and the Leeds Modernisation Team ‐ Disability for funding and other resources for the group and the research. Our thanks in particular are conveyed to the group participants. Additionally we thank the reviewers for their guidance. Aims: To explore the experience of aphasia within the context of communication, life participation and psychological well‐being and evaluate the outcomes of these phenomena in people with chronic aphasia following participation in a group intervention involving a social model approach. Methods & Procedures: A group of seven people with chronic moderate aphasia were assessed on communication measures, by means of the Conversational Analysis Profile for People with Aphasia (CAPPA), and aspects of psychological well‐being, by means of The Hospital Anxiety and Depression Scale (HADS) and The Visual Analogue Self‐esteem Scale (VASES) pre, post, and at 3‐month follow‐up of a group intervention. The group involved a social model approach and the use of Total Communication to support conversation. Speech and language therapy and social care personnel, including an equality disability trainer, contributed to the group. Outcomes & Results: Although variation in individual participants was demonstrated, results showed evidence of statistically significant beneficial change in conversation experiences (many of these related to life participation) and, to a lesser degree, beneficial change in conversation abilities. Additionally there were beneficial changes for some participants on psychological well‐being measures. Due to the small sample, participant variation, and (in the case of psychological well‐being measures) the lack of evidence of serious reduction in psychological well‐being at the outset, the results have to be evaluated with caution. Conclusions: Appropriately planned group intervention can produce benefits in conversation, life participation, and psychological well‐being in chronic aphasia.

The development and validation of the Visual Analogue Self-Esteem Scale (VASES).

OBJECTIVES To develop a visual analogue measure of self-esteem and test its psychometric properties. DESIGN Two correlational studies involving samples of university students and aphasic speakers. METHOD Two hundred and forty-three university students completed multiple measures of self-esteem, depression and anxiety as well as measures of transitory mood and social desirability (Study 1). Two samples of aphasic speakers (N = 14 and N = 20) completed the Visual Analogue Self-Esteem Scale (VASES), the Rosenberg (1965) self-esteem scale and measures of depression and anxiety. (Study 2). RESULTS Study 1 found evidence of good internal and test-retest reliability, construct validity and convergent and discriminant validity for a 10-item VASES. Study 2 demonstrated good internal reliability among aphasic speakers. CONCLUSION The VASES is a short and easy to administer measure of self-esteem that possesses good psychometric properties.

Communicating by telephone : Views of a group of people with stuttering impairment

Abstract A study of the use of and attitudes towards the telephone by persons with stuttering impairment is presented. Data was collected by survey (postal questionnaire). Results indicate that making calls may be more problematic than answering them. Avoidance-like behaviours were more prevalent amongst younger adult stutterers than their older counterparts. Severe stutterers use the telephone least. Many stutterers surveyed see telephoning as being more problematic than ‘face-to-face’ communication and give a range of reasons for this. Telephoning difficulties can have wide ranging effects. Some implications of these findings are discussed.

Benefits and losses: a qualitative study exploring healthcare staff perceptions of teamworking

Objectives: To examine staff perceptions of teamworking practice in the field of stroke care. Design: Qualitative interview study. Setting: Three teams providing care to patients with stroke across a typical care pathway of acute hospital ward, specialist stroke unit, and community rehabilitation. Participants: 37 staff members from a range of professions. Main outcome measures: Healthcare staff perceptions of teamworking. Results: Through detailed coding and analysis of the transcripts, five perceptions regarding the impact of teamworking on staff and patients were identified. These were: (1) mutual staff support, (2) knowledge and skills sharing, (3) timely intervention/discharge, (4) reduced individual decision-making and responsibility and (5) impact on patient contact time. Conclusions: Teamworking practice may be associated with a number of perceived benefits for staff and patient care; however, the potential for losses resulting from reduced patient contact time and ill-defined responsibility needs further investigation.

An evaluation of short-term group therapy for people with aphasia

This paper reports an evaluation of a group therapy intervention conducted with aphasic people (n = 6). The intervention comprised 10 sessions of approximately 90 min duration and included two participants with stuttering difficulties. The therapy programme consisted of communication activities within the group which encouraged sharing of personal experiences, videotaping of role-play activities for self- and group-evaluation and practice tasks completed outside the group. Measures of functional communicative ability, attitudes to communication and psychological adjustment were obtained before and after the intervention. Findings showed significant improvements in communicative competence and attitudes to communication over the course of the intervention. Before the intervention self-esteem and communicative competence were highly intercorrelated. By the end of the therapy sessions the correlation between self-esteem and communicative competence was significantly smaller and was non-significant. This indicates that communicative function was not related to feelings of self-worth by the end of the intervention. Improvements in attitude to communication, greater attendance and completion of assignments were each predictive of reduced levels of depression. There was also evidence that stronger beliefs about the role of personal effort in improving speech were predictive of improvements in communication attitudes. A measure of satisfaction showed extremely positive evaluation of the intervention by participants. It is concluded that shortterm group therapy can produce improvements in communicative abilities and attitudes, and have psychological benefits for participants. Several suggestions for future research are outlined.

The role of music therapy in an interdisciplinary approach to address functional communication in complex neuro-communication disorders: A case report

Purpose. This paper presents a case report of collaborative work between speech and language therapy (SLT) and music therapy (MT) in the case of an individual presenting with complex communication difficulties and lability caused by pseudo-Parkinsonian vascular disease. Design. MT intervention was used to investigate whether participation could be enabled in a client presenting with complex problems as well as facilitate change in communication parameters which remained unresponsive to conventional SLT intervention. A single case design measured communication and well-being parameters using pre-, during and post-intervention measures. In addition, analysis of the clients musical responses was undertaken to examine changes in vocal functioning which are involved in communication. Results. Analysis of the clients performance during MT intervention revealed improvements in prosody and phonation, with positive reports of participation, reduced incidence of lability and improvements in measures of well-being. Conclusions. The results indicate the value of such collaborative working in addition to making recommendations for the modification of existing treatment protocols. The findings highlight that fatigue is a major consideration when working with people with severe and complex clinical presentations.

The state of the art in non‐pharmacological interventions for developmental stuttering. Part 1: a systematic review of effectiveness

Abstract Background The growing range of available treatment options for people who stutter presents a challenge for clinicians, service managers and commissioners, who need to have access to the best available treatment evidence to guide them in providing the most appropriate interventions. While a number of reviews of interventions for specific populations or a specific type of intervention have been carried out, a broad‐based systematic review across all forms of intervention for adults and children was needed to provide evidence to underpin future guidelines, inform the implementation of effective treatments and identify future research priorities. Aims To identify and synthesize the published research evidence on the clinical effectiveness of the broad range of non‐pharmacological interventions for the management of developmental stuttering. Methods & Procedures A systematic review of the literature reporting interventions for developmental stuttering was carried out between August 2013 and April 2014. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for the identification of relevant studies included electronic database searching, reference list checking, citation searching and hand searching of key journals. Appraisal of study quality was performed using a tool based on established criteria for considering risk of bias. Due to heterogeneity in intervention content and outcomes, a narrative synthesis was completed. Main Contribution The review included all available types of intervention and found that most may be of benefit to at least some people who stutter. There was evidence, however, of considerable individual variation in response to these interventions. The review indicated that effects could be maintained following all types of interventions (although this was weakest with regard to feedback and technology interventions). Conclusions This review highlights a need for greater consensus with regard to the key outcomes used to evaluate stuttering interventions, and also a need for enhanced understanding of the process whereby interventions effect change. Further analysis of the variation in effectiveness for different individuals or groups is needed in order to identify who may benefit most from which intervention.

Speech and language therapy intervention in schizophrenia: a case study

BACKGROUND There is a significant body of evidence documenting the speech and language abnormalities found in adult psychiatric disorders. These speech and language impairments can create additional social barriers for the individual and may hinder effective communication in psychiatric treatment and management. However, the role of speech and language therapy in this patient population has not been extensively studied. AIMS Speech and language therapy is reported in a 53-year-old adult male patient who presented with severe poverty of speech as part of his diagnosis of schizophrenia. The aims of speech and language therapy focused on increasing the patients verbal communication using a combination of traditional and non-traditional speech and language therapy methods. METHODS & PROCEDURES Two phases of speech and language therapy were implemented. The first phase focused on desensitizing the patient to verbal communication. The second phase developed the patients language productivity and increased his awareness of his social communication skills. Five separate measures were taken as baselines which were repeated at the end of the intervention. OUTCOMES & RESULTS Post-intervention scores showed that the intervention was partly successful. The patients verbal communication increased and he developed more appropriate social communication skills. His negative attitude to communication remained unchanged even though his self-evaluative status improved. CONCLUSIONS The intervention is discussed in terms of the pre- and post-intervention measures and the role of speech and language therapy in schizophrenia. The study suggests that speech and language therapy can contribute to the understanding and management of schizophrenia and other adult psychiatric disorders.