Browsing by Author "Bixley, Morag"
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Item Open Access Aphasia management in an acute setting, what are we doing and why?(2014-09) Bixley, Morag; Blagdon, B.; Dean, M.; Langley, J.; Stanton, D.TITLE OF PAPER: APHASIA MANAGEMENT IN AN ACUTE SETTING, WHAT ARE WE DOING AND WHY? KEYWORDS: THERAPY, RATIONALES, EXPERTS • WHY THE STUDY WAS UNDERTAKEN The Specific Interest Group in Aphasia Therapy has been involved with two projects looking into what Speech and Language Therapists (SLTs) do for people with aphasia in the acute setting. In the first phase of their research Bixley et al (2011) collated the different activities reported by 86 SLTs from 55 different adult trusts. This research suggested that therapist activity could be divided into five categories. A follow up study (Bixley et al, 2013) asked SLTs to confirm these groups, estimate the amount of time spent on each activity and provide a rationale for why this therapy intervention was important. Twenty two therapists confirmed that their activities could be categorised into the five different types. Eight of these therapists were able to estimate the amount of time spent on each type of activity. These activities were: 1) Assessment - 32% 2) Multidisciplinary team working (MDT) - 26% 3) Therapy choices - 23% 4) SLT administration - 13% and 5) Support training and education (STE) - 6%. This paper expands on this research by presenting a grounded theme analysis of the rationales for intervention for people with aphasia in the acute setting. • HOW THE STUDY WAS DONE Therapists were asked to complete a short questionnaire that had been distributed opportunistically through the SIG network. Twenty two SLTs from 14 different NHS trusts participated in this research. Twenty one participants (95%) estimated that they spent an average of 43% of their time in work providing aphasia management. Typically they worked in departments of three therapists providing 17 sessions of acute aphasia care. Eleven therapists (50%) had less than five years SLT experience and typically were on pay scale 5 or 6. Four very experienced therapists (18%) who had worked for ten to twenty years were paid at band 8. • WHAT WAS FOUND AND IMPLICATIONS FOR FUTURE POLICY AND PRACTICE Rationales were provided for each of the five management options. Assessment: Words used to describe reasons for assessment activities (basis, develop, establish, estimate, focus, gain, guide, indicate, inform, make, plan, provide and suggest) indicate that assessment is an active, ongoing, reflective process. Assessment was linked to both therapist belief and recommended practice (Royal College of Physicians, 2012 and National Institute for Health and Clinical Excellence, 2013). MDT: Therapists reported that the role of MDT working was goal setting for the benefit of the client management. However some therapists were not employed as part of an MDT and found it difficult to influence this decision making process. Therapy: SLTs thought that impairment, functional and psychological therapies were equally important. They acknowledged that this was challenging in the acute sector where clients were discharged quickly and were not always well enough to engage fully with rehabilitation. 19/22 therapists (86%) suggested they would like more time to provide SLT input. This paper presents a consensus of current SLT expert opinion. Despite the small sample size this research could be used to guide targets for future SLT intervention in the acute sector and it could be used as a focus for discussion about intervention choices within the SLT profession. REFERENCES Bixley, M., Blagdon, B., Dean, M., Langley, J. & Stanton, D. (2013) Best practice for aphasia in the acute sector: a consensus of expert opinions. British Aphasiology Society Biennial International Conference Book of Abstracts, 8-9. Bixley, M., Blagdon, B., Dean, M., Langley, J. & Stanton, D. (2011) In search of consensus on aphasia management. Royal College of Speech and Language Therapists Bulletin, October, 18-20. Intercollegiate Stroke Working Party. (2012) National clinical guideline for stroke, 4th edition. London: Royal College of Physicians. National Institute For Health And Clinical Excellence. (2013) Stroke rehabilitation: 2nd guideline consultation.Item Open Access Aphasia teaching by the experts: A collaborative approach to undergraduate education(British Aphasiology Society, 2011-09-06) Bixley, Morag; DMU4 conversation group Aphasia LeicesterBackground information DMU4 is a once monthly conversation group for people with aphasia (PWA). It started in 2008 and is part of the Aphasia Leicester Group, an organisation created and run by PWA. The main purpose of the DMU4 conversation group is to give PWA an opportunity to meet and practise talking. Since October 2009 the group has provided teaching for second year Speech and Language Therapy students. Theoretical teaching is provided alongside the DMU4 learning experience to encourage students to link theory to practice. The conversation group learning opportunity also responds to clinical teacher feedback from student feedback that suggested that second year students would benefit from more confidence and greater skill in talking to PWA. Student training Although DMU4 is not directly modelled on the conversational partner scheme outlined by McVicker, Parr, Pound and Duchan (2007), the conversation group has adapted elements of the CONNECT training programmes to suit undergraduate conversation training. Before the group students are asked to prepare themselves by reading one of three noteworthy conversation based resources: Kagan & Gailey (1993), Kagan (1998) & Simmons-Mackie (1998). In a lecturer led pre group tutorial students are asked to discuss these papers and also discuss their perceptions about: their role in the group, how to start a conversation with a PWA, how to synthesise theory with practice and how to design an aphasia friendly feedback sheet. Students then participate in a two hour conversation group. In the first hour students experience talking to a PWA. At the end of the hour the students receive feedback from their conversational partner using the aphasia friendly feedback sheet created in the pre group tutorial. After coffee the students have a new conversation with different conversational partner and at the end of this hour the students receive feedback from their new partner. At the end of the group students are asked to evaluate the DMU4 learning experience and reflect on what they have learnt in a post group tutorial led by a PWA. Teaching evaluation Quantitative module evaluation has suggested that students think that the DMU4 experience is valuable. Qualitative module evaluation also suggested that students have benefiited from the experience as they reported gains in theoretical understanding (understanding of aphasia), gains in skill levels (increased ablity to use multi modality communication and increased ability to know how to adapt their level of language) and gains in clinical confidence. References KAGAN, A. & GAILEY, G. (1993) Functional is not enough: Training conversation partners for aphasic adults. In A. Holland & M. Forbes (Eds.) Aphasia Treatment: World Perspectives. San Diego: Singular Press. KAGAN, A. (1998). Supported conversation for adults with aphasia: Methods and resources for training conversation partners. Aphasiology, 12, 9, 816-830. McVICKER, S., PARR, S., POUND, C. & DUCHAN, J. (2007) The communication partner scheme: a project to develop long term, low cost access to conversation for people living with aphasia. Aphasiology, 23, 1, 52-71. SIMMONS MACKIE, N. (1998) Communiciation strategies used by “good” vs “poor” speaking partners of individuals with aphasia. Aphasiology, 12, 9, 831-838.Item Metadata only Aphasia – an information leaflet designed by people with aphasia.(British Aphasiiology Society, 2011-09-06) Bixley, Morag; DMU4 Conversation Group Aphasia Leicester; Hamilton, CatherineBackground information DMU4 is a conversation group for people with aphasia (PWA). It is part of Aphasia Leicester (AL), a stroke support group. In June 2010 the conversation group was asked to give feedback about aphasia friendly information leaflets that had been designed by the local Speech and Language Therapy department. This activity stimulated a lot of discussion within the group. It also proved to be a catalyst for the group to design their own information leaflet. They decided that they would like to produce a leaflet that had two purposes: explaining aphasia and advertising the long term support that AL could provide for PWA. The need for information leaflets about aphasia is supported by research such as the meta-analysis conducted by Smith, Forster and Young (2009) that suggested that only 55% of people with stroke and their carers understood the information they were given in hospital. It is also supported but the Care Quality Commission’s 2011 review of services for people who have had strokes and their carers which reported that only 38% of stroke services involved PWA in the design of their information leaflets. Leaflet design There were four leaflet design meetings. These meetings were facilitated by a Speech and Language Therapy lecturer. The initial meetings were used to identify the main ideas that the group thought should be incorporated into the information leaflet: how aphasia happened, what goes wrong when aphasia happens, what helps communication and emotions and contact details for Aphasia Leicester. A further two meetings were held to provide the leaflet designer with specific feedback about a first and final draft. Within these feedback meetings the group discussed how the information should be presented. Group members agreed with Hilari & Byng’s (2009) proposition that short sentences and pictographic representations of the main concept were useful. The group were in full agreement that writing needed to be larger than size 12 font and that arial font was the easiest to read. This unequivocal agreement does not support findings of the research review conducted by Howe, Worrall & Hickson’s (2004) that suggested that there was little agreement about how writing should be presented. Discussions were also focussed on the what colours should be used and whether white writing was accessible on a coloured background. Results This leaflet design activity addresses two of the eight main benefits associated with stroke group membership: accomplishing shared goals and establishing and confirming identity (Legg, Scott & Ellis, 2007). The activity also produced a leaflet, designed by PWA, that will be used to provide information about aphasia and provide a way to signposting voluntary organisation support for PWA and their relatives in the Leicestershire & Rutland area. References HOWE, T.J., WORRALL, L.E. & HICKSON, M.H. (2004) What is an aphasia-friendly environment? Aphasiology, 18, 11, 1015-1037. HILARI, K & BYNG, S. (2009) Health-related quality of life in people with severe aphasia. International Journal of Language and Communication Disorders, 44, 2, 193-205. LEGG, L., SCOTT, D. & ELLIS, G. (2007) Volunteer stroke service (VSS) groups for patients with communication difficulties after stroke; a qualitative analysis of the value of groups to their users. Clinical Rehabilitation, 21, 794-804. SMITH, J., FORSTER, A. & YOUNG, J. (2009). Cochrane review: information provision for stroke patients and their caregivers. Clinical Rehabilitation, 23, 195-206. CARE QUALITY COMMISSION (2011) Supporting life after stroke: A review of services for people who have had a stroke and their carers. London: Care Quality Commission.Item Open Access Aphasia: A mixed methods investigation into the impact of semantic activation therapy with and without word finding: preliminary results from a single therapy trial.(2017-06-27) Bixley, Morag; Jin, Lixian; Williamson, I. R.Abstract introduction Aphasia is a multimodality language difficulty experienced by people who have a left sided stroke. Speech and Language Therapists (SLTs) who work with People with Aphasia (PWA) often provide word finding therapy because wfd are one of the most debilitating effects of aphasic language loss. The majority of published word finding research uses mixed therapy techniques in which PWA practise accessing, using and combining sounds and words. This therapy trial is one of only three case studies that describe PWA receiving therapy that is purely semantic. Semantic therapy is particularly relevant to people with severe aphasia. This is because the evidence base underpinning language therapy for PWA supports therapy for people who can talk: very little research addresses the problems of those who have very limited access to output. This case study was designed to add to the evidence base that supports language therapy for people with severe aphasia who have no access to propositional speech. Abstract Method This paper reports on a single therapy trial conducted within a cohort of ten individual semantic therapy trails. Research design incorporated best practise recommendations for therapy studies (Brady et al, 2012, Tate et al, 2008 and Moher et al 2001). In the first six weeks of this single therapy trial, P participated in six therapy sessions of semantic therapy with word finding (SAT with). In a further six weeks of therapy P was provided with semantic therapy without word finding (SAT without). Results and conclusions Descriptive and statistical analysis of the impact of therapy suggested that P’s word finding skills improved after both types of semantic therapy. The effects of therapy generalised and were permanent. There was some suggestion that SAT with therapy was more successful that SAT without therapy, but this difference may have been attributable to an order effect. This abstract provides single clinical case evidence to support impairment based semantic therapy for people with severe aphasia.Item Metadata only Are sound cues easier than meaning cues and can online assessments be used as a productivity tool?(2014-09) Naylor, S.; Bixley, MoragTITLE OF PAPER: SOUND CUES ARE NOT ALWAYS EASIER THAN MEANING CUES KEYWORDS: APHASIA, CUEING, TECHNOLOGY • WHY THE STUDY WAS UNDERTAKEN This work was undertaken as part of an undergraduate programme of study. People with aphasia (PWA) experience word finding difficulties (WFD). Therapy may be provided to help PWA find words more easily (Royal College of Speech and Language Therapists, 2005). It is thought that the cueing hierarchy therapy technique (Rochford and Williams, 1962) may help PWA to access words more easily. Linebaugh and Lehner (1997) suggest that some cues are harder than others and that these cues should be used first, giving PWA the opportunity to access the word with little external help. Easier cues should then be presented in descending order of difficulty until PWA are able to find the word. Proponents of this therapy technique such as Thompson et al (2006), suggest that PWA are able to respond to sound cues more easily than they can respond to meaning based cues. This research project was designed to investigate whether people without aphasia have an inherent ability to use sound cues more readily than those based on meaning. A secondary objective was to assess the ease of designing and administering online assessments as an alternative to traditional methods. • HOW THE STUDY WAS DONE 40 people agreed to participate in this research and were randomly allocated to either a meaning cue assessment condition or sound cue assessment condition. Software was developed to enable standardised assessments over the phone. Using the online application, volunteers were asked to name 107 images of low frequency words. 57 of these images were objects or living things and the remaining 50 were corporate logos. After saying the word, the volunteer was asked to press the space bar to enable the next image to appear. If the volunteer was unable to find a word, cues were provided. In the meaning condition, a highly associated word was provided as a cue and in the sound condition, the first sound of a word was provided. These cues were given to try and stimulate word finding. If the participant was entirely unable to access the word, they were asked to identify the target word from a choice of three written words. • A SUMMARY OF MAIN RESULTS Results suggested that when participants were asked to find words for objects and living things, sound cues were more effective than meaning cues. Statistical analysis using Levene’s test of equivalence (p0.618) and subsequent t-test (p 0.00014) revealed a significant difference between the two conditions. This significant difference was not evident when participants were asked to name corporate logos. For this type of vocabulary, meaning cues showed a slight advantage over sound cues. Online assessments can have beneficial effects on the consistency of administration and shorten the time required to assess participants. • IMPLICATIONS FOR FUTURE POLICY AND PRACTICE The results of this research suggest that cueing hierarchies are dependent, not only on the client, but also on the concept selected as the target for therapy. Low frequency words and abstract concepts do not respond to cueing in the same way as frequent and imageable words. This has implications for the way in which therapists provide cueing therapy for PWA. This project also provides support and direction for the use of technology in the assessment and remediation of word finding difficulties for people with aphasia. • REFERENCES Linebaugh, C.W. and Lehner, L.H. (1997) Cueing hierarchies and word retrieval: A therapy program. In R.H. Brookshire (Ed.) Clinical Aphasiology Conference Proceedings. Minneapolis: BRK Publishers. Rochford, G. and Williams, M. (1962). Studies in the development and breakdown in the use of names. Journal of Neurology, Neurosurgery and Psychiatry, 25, 222-227. Royal College Of Speech And Language Therapists (2005) Clinical Guidelines. Bicester: Speechmark. Thompson, C.K., Kearns, K.P., Edmonds, L.A. (2006) An experimental analysis of acquisition, generalisation and maintenance of naming behaviour in a patient with anomia. Aphasiology, 20, 12, 1226-1244.Item Metadata only Best practice for aphasia in the acute sector: a consensus of expert opinions(2013-09) Bixley, Morag; Blagdon, B.; Dean, M.; Langley, J.; Stanton, D.Background Information Historically Speech and Language Therapy (SLT) intervention has been guided by a, sometimes bewildering, plethora of standards and guidelines. Publications such as those written by the Royal College of Physicians (2012), the National Institute for Health and Clinical Excellence (2013) and Bowen et al (2012), guide our input within the acute setting. In 2011, the SIG Aphasia Therapy published the results of a survey into the practices of 86 SLTs who worked in 55 different adult SLT trusts (Bixley et al, 2011). The results of the 2011 study suggested that 172 different and appropriate management options could be sorted into five categories. This current study was designed to investigate whether the hypothesised categories in the original research described current working practices. Method Twenty two therapists, from 14 different NHS trusts, responded to a questionnaire that was distributed opportunistically through the SIG network. Thirteen (59%) had less than five years SLT experience and typically were on pay scale 5, 6 or 7. Four very experienced therapists (18%) who had worked for ten to twenty years were paid at band 8. Ten (45%) were employed full time. Fourteen (64%) worked in posts split between acute stroke units and the community. On average, the twenty two SLTs worked in departments of three therapists providing 17 sessions of acute aphasia care per week. Twenty one SLTs (95%) estimated that they spent on average 43% of their time in work providing aphasia management. Results All twenty two therapists confirmed the five categories and twenty five intervention aims derived from the original research and eight therapists were able to estimate the time spent on each type of activity. Definitions were: 1) Assessment (32%) informal, formal, case history, outcome, screening, mental capacity 2) Multidisciplinary team working (MDT) (26%) writing guidelines and documentation, joint sessions, attending discharge and MDT meetings, goal setting 3) Therapy choices (23%) language therapy, establishing functional communication, low tech AAC, providing accessible environment, group work, computer therapy, outings 4) SLT administration (13%) plan discharge liaise and refer onwards, prioritise and make resources, write notes and keep statistics 5) Support training and education (STE) (6%) client, family, assistant practitioners, MDT. Discussion This description of SLT management choices adds a classification system and a level of detail that is not available elsewhere in the literature. Detail and differentiation about SLT intervention is important in much the same way different doses of a drug affect pharmacological outcomes. Our findings confirm that assessment, STE and conversation therapy should be located firmly within the basic remit of SLT. Significantly 52/86 therapists (60%) in our initial investigation and 19/22 (86%) therapists in our follow up research suggested that they did not have enough time to provide therapy for people with aphasia in the acute setting. References BIXLEY, M., BLAGDON, B., DEAN, M., LANGLEY, J. & STANTON, D. (2011) In search of consensus on aphasia management. Royal College of Speech and Language Therapists Bulletin, 2011, October, 18-20. BOWEN, A., HESKETH, A., PATCHICK, E., YOUNG, A., DAVIES, L., VAIL, A., LONG, A.F., WATKINS, C., PEARL, G., LAMBON RALPH, M. A. & TYRELL, P. Effectiveness of enhanced communication therapy in the first four months after a stroke for aphasia and dysarthria: a randomised controlled trial. British Medical Journal, 2012, 345, 1-15. INTERCOLLEGIATE STROKE WORKING PARTY. (2012) National clinical guideline for stroke, 4th edition. London: Royal College of Physicians. NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. (2013) Stroke rehabilitation: 2nd guideline consultation.Item Metadata only Collaborative working: Speech and Language Therapy and the Stroke Association.(2012-09) Scantlebury, K.; Bixley, Morag; Smith, G.TITLE OF POSTER: - COLLABORATIVE WORKING: SPEECH AND LANGUAGE THERAPY AND THE STROKE ASSOCIATION KEYWORDS: GROUNDED THEORY, CONTINUOUS NEGOTIATION, MECHANISMS FOR COLLABORATION INTRODUCTION The recent Care Quality Commission special review (2011 p15) suggested that only 40% of adult social services provide advice about community-based services for people with aphasia following a stroke. The Speech and Language Therapy (SLT) Department and the Stroke Association (SA) Communication Support Co-ordinator (CSC) in King’s Lynn provide communication support using a joint working approach. This SLT and voluntary sector partnership is recommended by the Royal College of Speech and Language Therapists (2007 p12) and the Department of Health (2007 p42). However the evidence base for co-ordinated community support for people with communication difficulties following stroke is limited. This study was designed to investigate the innovative collaboration between the SLT stroke team and the Stroke Association in West Norfolk. The aims of the study were to: define and evaluate this partnership and identify factors that influenced the success of this joint working approach. Approval for this research was given by the Queen Elizabeth NHS Trust Kings Lynn, Research and Development Office, the Stroke Association and De Montfort University, Leicester. RESEARCH METHOD Four individual interviews were carried out with SLTs and CSCs in the West Norfolk Stroke service. Questions were standardised across all interviews and were designed to be open and non directive. Interviews were recorded, transcribed and then analysed using a grounded theme analysis. Simmons-Mackie et al (2007) describe grounded theory analysis as a reflexive process through which common issues and threads can be sorted into natural groups, subcategories and contrasts. This research methodology was developed in sociology and is used extensively across health professions. Skeat & Perry (2008) suggest that the use of grounded theory is particularly useful for research into topics that have restricted or absent theoretical underpinnings such as the area addressed by our study. SUMMARY OF RESULTS AND CONCLUSIONS The results of this pilot study allowed the researchers to explore the use of grounded theory as a mechanism for uncovering, the nature of and attitudes to, partnership working between SLTs and CSCs. Interview analysis identified a simultaneous, collaborative, reciprocal, joint communication pathway that started in the acute setting and continued past discharge into the community and through to long term communication support. Interview analysis suggested that there are specific difficulties inherent in this type of independent collaboration. Analysis suggested that the West Norfolk scheme was successful because the collaboration involved active and continuous negotiation and re negotiation between the SLT service and the SA. Negotiations initiated by the CSC at the start of the SA communication support service facilitated successful start up of the collaboration. Discussions that showed, an awareness and empathy of the role and responsibilities of others, contributed to successful joint working. The teams also employed mechanisms such as: joint shadowing, two way referrals, joint projects, continuity of staff team across acute and community care. These factors appeared to engender productive working relationships. It is hoped that these initial findings can be used to promote successful collaboration between our profession and the voluntary sector. In the future it is hoped that this study will be extended to encompass the views of more participants providing different communication pathways. REFERENCES Care Quality Commission (2011) Supporting life after stroke: A review of services for people who have had a stroke and their carers. London: Care Quality Commission. Department of Health (2007) National Stroke Strategy. London: Department of Health. Royal College of Speech and Language Therapists (2007) Policy statement: The contribution of Speech and Language Therapists along the care pathway of stroke survivors. London: Royal College of Speech and Language Therapists. Simmons-Mackie, N.N., Kagan. A., O'Neill Christie, C., Huijbregts, M., McEwen, S. & Willems, J. (2007) Communicative access and decision making for people with aphasia: Implementing sustainable healthcare systems change. Aphasiology, 21, 39-66. Skeat, J. Perry, A. (2008) Grounded theory as a method for research in speech and language therapy. International Journal of Language and Communication Disorders, 43, 2, 95-109.Item Open Access Communication confidence in different settings: perceptions of nineteen people with aphasia(2013-09) Hayward, K.; Bixley, MoragCommunication confidence in different settings: perceptions of nineteen people with aphasia Background This small scale study was undertaken as part of an undergraduate degree. Aphasia is a clinical entity that can be defined in a literal way. It can also be described as a catalyst that results in a change in identity, and therefore also has emotional meaning for the people it affects. This latter description can be aligned with the social model that suggests that individuals are not intrinsically disabled, rather they are disabled by the society in which they live. Understanding and measuring the emotional effects of communication disability is challenging. In a recent single case study investigation Babbit & Cherney (2010) introduced a measure that examined the relationship between aphasia, communicative confidence and identity after a stroke, the Communication Confidence Rating Scale for Aphasia (CCRSA). Our study widened the scope of the original Babbit & Cherney (2010) study and used the CCRSA to investigate whether the communicative confidence of nineteen people with aphasia (PWA) was affected by their environment. Method Participants were recruited from two aphasia support groups operating in two different parts of Britain. The 12 men and 7 women who participated in this study were aged between 41 and 77 and had lived with their aphasia for an average of seven years. The PWA were asked to complete the CCRSA. Adaptations were introduced to enable a comparison between communicative confidence in three different settings: home, community and support group. Aphasia friendly adaptations (Dalemans et al, 2009 and Bixley et al, 2011) also ensured that the PWA, irrespective of the severity of their aphasia, were able to respond to the questionnaire independently. Results Questionnaires were collated and analysed statistically. Results suggested that participants were confident communicating at home and within support groups. PWA were not confident communicating in public. Findings were statistically significant. Participants reported that they were most confident (80%) talking to family and friends and were least confident when they used the telephone (26%). Discussion The results of this study suggest that PWA do not feel confident communicating in public or using the telephone. These findings confirm the perception that the societal barriers described by Pound et al (2000) prevent PWA accessing the society in which they live. The very similar positive confidence ratings for home and support groups provide a rationale for the benefits of long term group intervention and support for PWA. Our findings also suggest that the CCRSA may be a useful outcome measure that could be used to evaluate the positive effect that Speech and Language Therapy intervention can have on the communicative confidence of PWA. References BABBIT, E.M. & CHERNEY, L.R. (2010) Communication confidence in persons with aphasia. Topics in Stroke Rehabilitation, 17, 3, 214-223. BIXLEY, M., DMU4 & HAMILTON, C. (2011) Aphasia – an information leaflet designed by people with aphasia. British Aphasiology Society Biennial International Conference Book of Abstracts, 12. DALEMANS, R. (2009) Facilitating the participation of people with aphasia in research: A description of strategies. Clinical Rehabilitation, 23, 2, 948-959. POUND, C., PARR, S., LINDSAY, J. & WOOLF, C. (2000) Beyond Aphasia: Therapies for Living with Communication Disability. Bicester: Winslow.Item Open Access Constraint-Induced aphasia therapy: Three single case studies.(2012-09) O'Hora, R.; Bixley, Morag; Finney, C.; Haynes, J.; Small, L.TITLE OF POSTER: CONSTRAINT INDUCED APHASIA THERAPY - THREE SINGLE CASE STUDIES INTRODUCTION This research project was inspired by the Specific Interest Group in Aphasia study day given by Professor Pulvermuller in January 2011. Constraint Induced Aphasia Therapy (CIAT) is sometimes referred to as Intensive Language Action Therapy (ILAT). This technique has an impressive research base to support its use for people with aphasia (PWA) and the evidence base includes both single case and randomised control trial evidence (Pulvermuller, Neininger, Elbert, Mohr, Rockstroh, Koebbl & Taub, 2001). Pulvermuller et al (2001) describe CIAT as a game of pairs. The game is normally played by four players: a therapist and three PWA. A 32 pack of cards consisting of 16 pairs is shuffled and divided equally between the four players. No one can see anyone else’s cards. The aim of the game is to win the most pairs of cards. Clients can win a pair by asking each of the other players in turn, for a matching card. All requests and responses should be verbal but participants may describe the target word or use a gesture in order to achieve saying the word. An essential part of the game is that each player should see and hear the name of the card in play. RESEARCH METHOD Three PWA were prioritised from a typical general hospital SLT caseload. All three clients were one to two years post onset of their aphasia and had already been provided with impairment focussed, functional and psychosocial SLT input. They had moderate to severe aphasia, had difficulties at several levels of single word processing and frequently failed to convey their message despite having a degree of linguistic competence and an ability to use alternative communication strategies. Accessible formal assessment measures (Kaplan, Goodglass & Weintraub 1983, Goodglass, Kaplan & Barresi 2000 & Swinburn, Porter & Howard 2004) were used to evaluate the success of therapy in a four step repeated measures research design: Baseline 1, 30 hours CIAT therapy, Baseline 2, Baseline 3. SUMMARY OF RESULTS For 2/3 clients, assessment results suggested that participation in the CIAT programme resulted in a positive measurable change in language behaviour. This positive change was not apparent in assessments of understanding. Selective improvement of language ability suggests that the therapy directed at language output had resulted in improved word and sentence level skills for 2/3 of our clients. There were also positive changes that were not captured by the assessment data: reduced use of written and therapist cues, improved repetition skills, improved self-monitoring and a reduced tendency to produce jargon type utterances. Relatives corroborated therapist perceptions. CONCLUSIONS In 2006 Beeson & Robey (2006, p162) proposed that rehabilitation outcome research should be conducted in five phases. Our study is one of the first to provide evidence to support the use of intensive CIAT therapy in the community (phase 4 – an effectiveness study). Other studies have assessed the usefulness of the therapeutic effect of ILAT (phase 1), optimised the ILAT procedure (phase 2) and tested its usefulness under ideal conditions (phase 3). The final phase outlined by Beeson & Robey (2006) is the cost-benefit analysis (phase 5) and we would welcome debate within the profession on improving this type of input and the role of Speech and Language Therapists in intensive aphasia therapy provision. REFERENCES Pulvermuller, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbl,P. & Taub, E. (2001) Constraint induced therapy for chronic aphasia after stroke. Stroke, 1621-1626. Beeson, P. M. & Robey, R.R. (2006) Evaluating single-subject treatment research: Lessons learnt from the aphasia literature. Neuropsychological Review, 16, 161-169. KAPLAN, E., GOODGLASS, H. and WEINTRAUB, S. (1983) The Boston Naming Test. Philadelphia: Lea and Febiger. Goodglass, H., Kaplan, E. & Barresi, B. (2000) Boston Diagnostic Aphasia Examination. 3rd Edition. San Antonio: Pearson. Swinburn, K., Porter, G., & Howard, D. (2004). The Comprehensive Aphasia Test. Hove: Psychology Press.Item Open Access Exploring accounts of collaborative working between speech and language therapists and communication support coordinators following stroke(Taylor and Francis, 2018-03-09) Scantlebury, K.; Bixley, Morag; Williamson, I. R.In the United Kingdom, speech and language therapists (SLTs) and Stroke Association communication support coordinators (CSCs) are both employed to provide services for people with communication difficulties following stroke. There is very little literature about this type of collaborative working. This research is unique because it explores collaborative working between SLTs who are employed by the National Health Service and CSCs who are employed by the Stroke Association. Five CSCs and seven SLTs from the East of England participated in a series of in-depth interviews. Data were analysed using thematic analysis informed by an interpretative phenomenological approach. Analysis suggested complex negotiation processes occur at a number of different levels. These levels include negotiation of individual relationships between SLTs and CSCs, negotiating the particular challenges involved in working across organisations and professions, and the need for both roles to negotiate and promote the value of their services at a societal level. The findings of this research are discussed in relation to existing theories and research within the field of collaborative working. Clinical applications are suggested for collaborative working within communication services. We propose that our findings may have relevance to other individuals and organisations delivering services collaborativelyItem Open Access Exploring accounts of joint working between Speech and Language Therapists and Stroke Association Communication Support Coordinators(2016-11-28) Scantlebury, K.; Bixley, Morag; Williamson, I. R.Exploring accounts of joint working between Speech and Language Therapists and Stroke Association Communication Support Coordinators Introduction Both Speech and Language Therapists (SLTs) and Stroke Association Communication Support Coordinators (CSCs) are employed across the UK to provide services for people with communication difficulties following Stroke. The two roles are usually employed by different sectors and are subject to very different levels of qualification and professional regulation. Despite recommendations that the two roles work together, there is little existing literature examining current practices of joint working between SLTs and CSCs. Method Data were collected through a series of in depth individual interviews with five CSCs and seven SLTs working within the East of England. Data were analysed inductively using Thematic Analysis (Braun & Clark, 2006). Results Six themes were developed which highlighted the perceived benefits and challenges in this example of cross sector working. Both SLTs and CSCs identified strong incentives for joint working. The themes developed suggested a number of processes are engaged in negotiating the joint working relationship. These include ‘Developing and earning trust and respect’; ‘Pushing to establish place’; and ‘Struggling against external pressures and threats’. In addition, two further themes were developed to explore the process of finding agreement in the division of workload: ‘Sharing Out’ of aphasia; and ‘Local level Negotiation and Matching of expectations’. Conclusions: The findings suggest a number of unique features which characterise joint working relationships between SLTs and CSCs. Clinical applications based on the findings are discussed, along with suggested areas for further research.Item Open Access Exploring accounts of joint working between Speech and Language Therapists and Stroke Association Communication Support Coordinators(2016) Scantlebury, K.; Bixley, Morag; Williamson, I. R.Exploring accounts of joint working between Speech and Language Therapists and Stroke Association Communication Support Coordinators Introduction Both Speech and Language Therapists (SLTs) and Stroke Association Communication Support Coordinators (CSCs) are employed across the UK to provide services for people with communication difficulties following Stroke. The two roles are usually employed by different sectors and are subject to very different levels of qualification and professional regulation. Despite recommendations that the two roles work together, there is little existing literature examining current practices of joint working between SLTs and CSCs. Method Data were collected through a series of in depth individual interviews with five CSCs and seven SLTs working within the East of England. Data were analysed inductively using Thematic Analysis (Braun & Clark, 2006). Results Six themes were developed which highlighted the perceived benefits and challenges in this example of cross sector working. Both SLTs and CSCs identified strong incentives for joint working. The themes developed suggested a number of processes are engaged in negotiating the joint working relationship. These include ‘Developing and earning trust and respect’; ‘Pushing to establish place’; and ‘Struggling against external pressures and threats’. In addition, two further themes were developed to explore the process of finding agreement in the division of workload: ‘Sharing Out’ of aphasia; and ‘Local level Negotiation and Matching of expectations’. Conclusions: The findings suggest a number of unique features which characterise joint working relationships between SLTs and CSCs. Clinical applications based on the findings are discussed, along with suggested areas for further research.Item Open Access Happiness and aphasia groups(2014-09) Cowles, H.; Bixley, MoragTITLE OF POSTER: HAPPINESS AND APHASIA GROUPS KEYWORDS: INTERACTION, WELLBEING, OUTCOME WHY THE STUDY WAS UNDERTAKEN The National Clinical Guidelines for stroke (Royal College of Physicians, 2012) highlight the importance of long term, continuing support for people living with aphasia (PWA). It is recognised that PWA may have difficulties maintaining psychological wellbeing post stroke especially after discharge from Speech and Language Therapy services. There is an emerging evidence base to support the premise that attending support groups may enhance the PWA’s feelings of confidence and wellbeing in the community (Van der Gaag, 2005). This undergraduate project was designed to add to this evidence base. Fourteen PWA were asked to share their feelings about how meeting others with aphasia contributed to their overall feelings of happiness and wellbeing. • HOW THE STUDY WAS DONE The Fourteen PWA, seven from two different community groups, volunteered to participate in this research. Average age Women Men Boston Diagnostic Aphasia Examination Severity Rating Scale (Goodglass and Kaplan, 2001) Severe 0 1 2 3 4 Mininal 5 65.7 8 6 - - 4 PWA 4 PWA 3 PWA 3 PWA Volunteers were interviewed and asked to rate their feelings of happiness using a version of Ryff’s (1989) psychological wellbeing scale that had been adapted for PWA by Hoen et al (1997). Ryff’s (1989) happiness scale is made up of six dimensions that are thought to contribute to emotional wellbeing: self acceptance, independence, positive relations with others, purpose in life, personal growth and the ability to control different environmental situations. Within each of these dimensions PWA were asked to rate four statements on a five point likert scale. The addition of an additional statement “Attending this support group has made me happier” resulted in a twenty five question scale with a possible strength of agreement total of 125. WHAT WAS FOUND 12/14 PWA reported that that their participation in support groups had made them happy. The average total score on Ryff’s (1989) psychological wellbeing scale was 89.5 (71.6%). Statistical analysis was used to compare the differences between the mean score of each dimension. Levene’s test and subsequent independent t tests suggested that PWA felt more positively their ability to be autonomous, (mean 15.21, p 0.001) experience personal growth (mean 15.14, p0.001) and enjoy positive relations with others (mean 15.5, p0.002) compared to their ability to control their environment (mean 11.93). There did not appear to be a relationship between the severity of aphasia and psychological wellbeing overall score. IMPLICATIONS FOR FUTURE POLICY AND PRACTICE These results add to the growing evidence base that demonstrates the beneficial effects of support groups for PWA. This project also suggests that Ryff’s (1989) scale may be a useful outcome measure for this client group. The results from this limited sample of participants suggest that PWA experience happiness within support groups. Whilst ratings in response to statements such as: “The demands of every day life often get me down” “I can manage the many responsibilities of my daily life” “I feel defeated because I can’t keep up with everything I have to do” suggest that daily life with aphasia is challenging and at times overwhelming. This is despite the ongoing and valuable care provided by support groups such as those described in this research. REFERENCES Goodglass, H. & Kaplan, E. (1983). Boston Diagnostic Aphasia Examination Test. (2nd edition). Baltimore: Lippincott, Williams and Wilkins. Hoen, B., Thleander, M. and Worsley, J. (1997). Improvement in psychological wellbeing of people with aphasia and their families: evaluation of a community based programme. Aphasiology, 11, 681-691. Royal College of Physicians (2012). National Clinical Guideline for Stroke. (4th Edition). London: Royal College of Physicians. Ryff, C. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological wellbeing. Journal of Personality and Social Psychology, 57, 6, 1069-1081. Van der Gaag, A., Smith, L., Davis, S., Moss, B., Cornelius, V., Laing, S. and Mowles, C. (2005). Therapy and support services for people with long term stroke and aphasia and their relatives: a six-month follow up study. Clinical Rehabilitation, 19, 4, 372-380.Item Open Access In search of consensus on aphasia management.(2011-10) Bixley, Morag; Blagdon, B.; Dean, M.; Langley, J.; Stanton, D.Item Open Access An investigation into what two hundred and nine members of the British Public Know about cleft lip and palate(2021-10-05) De Boer, Jessica; Bixley, MoragIntroduction Rationale This project was conducted as part of an undergraduate BSc (Hons) Speech and Language Therapy degree programme. The study was designed to explore what members of the British Public know about cleft lip and cleft palate. Within the current and limited evidence base, the lack of evidence about what cleft lip and palate are is a common theme (Alnujaim et al., 2017; Owotade et al., 2014; Sagwala, 2018). Only two of the studies exploring knowledge about cleft lip and palate specifically investigate what the public know about cleft lip and cleft palate (Middleton et al, 1986; Wallace and Arellano, 2018) but neither of these studies were conducted in Britain. Aims of the Study This study was designed to find out what people in Britain know about cleft lip and palate and to consider the results of this present study with the investigations conducted in America (Middleton et al, 1986) and Australia (Wallace and Arellano, 2018) to see if there are key findings that might positively influence the lives of those living with cleft lip and palate. Methods Used An online qualitative and quantitative questionnaire generated through google forms was circulated opportunistically through facebook and friendship groups. The 14 questions were based on questions used in previous studied and were designed to investigate what people know about cleft lip and cleft palate and how they acquired this knowledge. Results The results of the study suggested that the 209 people who had responded to the invitation to take part in this study knew more about cleft lip than cleft palate. Respondents knew that people with cleft lip and palate may also have problems with speech, feeding, dentition, hearing, bullying and confidence and 74% of respondents could list more than one of these difficulties. Despite 168 people identifying speech as a difficulty associated with cleft lip and palate, only 82 survey responses identified that people with cleft lip and palate might benefit from Speech and Language Therapy intervention. The study found no link between more education and increased knowledge. Conclusions and Contributions to new knowledge The results of this preliminary investigation suggest that cleft lip cleft palate is not very well understood within this very limited sample of the British public but it is higher than has been found in previous studies (Middleton et al, 1986; Wallace and Arellano, 2018). Greater awareness of what it means to have cleft lip and cleft palate may facilitate academic development, social integration and psychological wellbeing Implications for practise As Speech and Language Therapists, it would be beneficial to target raising awareness of cleft palate, within our sphere of influence. It may also be relevant to highlight and disseminate more widely the positive benefits of services that can support living successfully with cleft lip and palate such as Surgery, Feeding support, Speech and Language Therapy, Dentition and Orthodontic Services, and Audiology.Item Open Access A mixed method investigation into the impact of activation therapy with and without word finding for people with aphasia(De Montfort University, 2021) Bixley, MoragBackground Information Impairment based therapy studies for people with aphasia indicate that therapy which involves word finding practice can help people with aphasia find words. Research has also suggested that the impact of therapy can generalise to other words not used in therapy and that it can have a positive impact on communication skills and feelings of wellbeing. This research project introduces a novel word finding therapy. Activation therapy was designed for people with all types of aphasia, even those who have difficulty representing their own views or cannot express their thoughts at all. There is very little evidence base to support a word finding therapy that does not involve overt word finding practice and this limited support is based on the results of three separate therapy studies and its beneficial impact on the word finding skills of five people with aphasia. This therapy trial compared the impact of activation therapy with and without word finding to see if its impact was contingent on the opportunity to practise word finding out loud. It was also designed to evaluate two additional therapy outcomes; the impact of activation therapy on sentence grammar and its impact on the experience of living with aphasia. Methodology This research was designed to conform to therapy trial standards as far as practicable. Seven people with aphasia and their therapy trial partners volunteered to participate in this study. All participants had suffered a left sided cerebrovascular stroke and were at least nineteen months post onset of their aphasia. Participants were diverse in terms of aphasia severity, type of aphasia, age, and pre stroke occupation, however they were all united in their need to receive more aphasia therapy than they had been offered. ttps were related to participants in different ways and were either spouses, partners, parents or the offspring of the seven participants with aphasia. The research design was informed by aphasia therapy trial precedents and followed an “a b a c a” design. Participants were provided with three pre therapy assessment sessions, six activation therapy with or without word finding sessions, three mid therapy assessment sessions, a further six sessions of activation therapy with or without word finding, and finally three post therapy assessments. Random allocation to counterbalanced pathways, verification of stable baselines, and three types of control tasks were used to address possible threats to the integrity of the crossover research design. Participants completed three 260 word finding assessments in each assessment phase. Participants and their therapy trial partners were also interviewed during each assessment phase. Assessments of sentence comprehension and non-verbal problem solving were conducted during pre and post therapy assessment phases and were used as two of the control measures from which the impact of activation therapy could be inferred. Initial word finding assessments were used to identify words which had caused word finding difficulties. For each participant, the words that they had found difficult to say were allocated to one of three equivalent word finding sets, activation therapy with word finding set, activation therapy without word finding set and a control group set. During activation therapy sessions participants listened to the therapist describing each word. Descriptions included at least eight relevant pieces of information about the word. Its appearance, function, most obvious feature, location, category membership, co-ordinates, closely related objects, synonyms, antonyms, subtypes, parts, use in collocations, use in idioms, use in frequent sentences and idiosyncratic associations. Participants were then asked to identify the object that had just been described from an array of five pictures that contained the target picture and four of its coordinates. The only difference between the two activation therapy techniques was that activation therapy with word finding sessions included participants practising saying the word that had just been described and participants were provided with the opportunity to practise saying the word eleven times before listening to the description of the next therapy item. Results Statistical analysis of group results suggested that activation therapy improved the word finding skills of the seven participants with aphasia. A lack of comparable improvement in control tasks suggested that improved word finding skills could be attributed to activation therapy rather than other possible factors such as improved attention, executive functioning, therapeutic alliance or other non-specific effects of attending Speech and Language Therapy sessions. There was however, no statistical difference between the impact of activation therapy with word finding and activation therapy without word finding, suggesting that spoken word finding practice was not an essential part of successful word finding therapy. Grammatical analysis of word, phrase and sentence level output elicited during therapy experience interviews identified only one indicator of the generalisation activation therapy to everyday speech. All seven participants used longer noun phrases after twelve weeks of aphasia therapy. Finally, thematic analysis therapy experience interviews with participants and their therapy trial partners suggested that activation therapy had resulted in positive perceptions of changes in language use and participants’ relationships with themselves, their close others and their interactions with people in the wider community, the other others. Triangulation and integration of these findings suggested that activation therapy may have altered the accessibility of nouns and noun syntax which was apparent in word finding assessments and spontaneous language use. Discussion This small scale therapy trial supports the implementation of aphasia therapy for people who are not happy living with their aphasia. Three complementary evaluation methods identified the meaningful impact of activation therapy in improved word finding in assessments, improved noun phrase structure, and enhanced wellbeing, a triangulation and integration of converging evidence. In this therapy trial, changes in word finding skills could not be attributed to overt word finding practice. The need to practise words is a notion that has guided aphasia therapy research and has framed the way that outcomes have been measured in this field. It has also dictated the type of participant that can take part in research and by implication has affected which type of person with aphasia can be provided with intervention that is evidence based. The equal impact of activation therapy with and without word finding on the words analysed in this therapy trial can be explained by both prominent models of single word processing, interactive and modular. Analysis of meaning word finding difficulties and generalisation to words not targeted in therapy aligned more closely to the interactive models of conceptualisation of single word processing. Neither model adequately explained the overuse of plural markers and relative lack of sound processing difficulties experienced by the seven participants in the study. It is hoped that the findings of this small scale therapy study may contribute to future discussions about the nature of word finding with and without aphasia. It is also hoped that it this study will contribute to the evidence base that supports the implementation of aphasia therapy for those who live with language difficulties.Item Open Access People with aphasia creating an aphasia friendly website: The DMU4 experience(2013-09) Bixley, Morag; DMU4; Hall, Richard; Weale, Robert; Collingwood, J.; Marshall, F.; Hamilton, C.People with aphasia creating an aphasia friendly website: The DMU4 experience Bixley,M., DMU4, Hall, R., Weale, R., Collingwood, J., Marshall, F. & Hamilton, C. Background Information The DMU4 Conversation group is part of Aphasia Leicester; a community based, voluntary sector, long term support organisation for People with Aphasia (PWA). Members of DMU4 have experienced being unable to access information about their condition because of the way in which the information is presented. These personal experiences are supported by research such as the Care Quality Commission’s (2011) report that suggested that only 40% of social services in Britain provided information in an accessible way for PWA post stroke. In 2011, DMU4 created a leaflet about aphasia that was designed to be used in acute hospitals to educate stroke survivors, relatives and hospital staff about aphasia (Bixley et al, 2011). This leaflet has been distributed to hospitals, surgeries and Speech and Language Therapy Departments in Leicestershire and Rutland. Last year DMU4 decided that they would like to embark on a new project; creating a website about aphasia that was also accessible to PWA. Method The group decided that there were three main factors that needed to guide the construction and structure of the website. Firstly, people with aphasia would appear on the website as aphasia experts. Secondly, navigation around the website should be aphasia friendly, based on visual images and accessible written language. Lastly, members of DMU4 would retain copyright over their own images. For this reason, the site was hosted on “Our DMU Commons” a self organising space that allows users to co construct their own website using open source software. The content of the website was agreed through group discussions. Following these discussions, nine DMU4 members attended a whole day filming session in which their perceptions of aphasia were recorded. Films were then transcribed and edited into eleven themes using a grounded approach. Skeat & Perry (2007) suggest this approach is useful when investigating information that is not available anywhere else, such as the information presented in this website. Informed consent was elicited through discussions, meetings, film and website screenings and signed agreement. Results and discussion The DMU4 website project has two tangible outcomes. The first is that the site will be available to people who want to learn about aphasia. The second is that the resource will be available for Speech and Language Therapy students. Learning activities will enable students to practise recognising and understand aphasia from the perspective of those who live with the loss of language post stroke. The practices of DMU4 are rooted firmly in the social approach to aphasia therapy (Pound, Parr, Lindsay and Woolf, 2000). It is hoped that the website’s third, less measurable, outcome will be a contribution to overcoming the attitudinal and informational barriers that are experienced by PWA post stoke. References BIXLEY, M., DMU4 & HAMILTON, C. (2011) Aphasia – an information leaflet designed by people with aphasia. British Aphasiology Society Biennial International Conference Book of Abstracts, 12. CARE QUALITY COMMISSION (2011) Supporting life after stroke: A review of services for people who have had a stroke and their carers. London: Care Quality Commission. SKEAT, J. & PERRY, A. (2008). Grounded theory as a method for research in speech and language therapy. International Journal of Language and Communication Disorders, 43, 2, 95-109. POUND, C., PARR, S., LINDSAY, J. & WOOLF, C. (2000) Beyond Aphasia: Therapies for Living with Communication Disability. Bicester: Winslow.Item Open Access People with aphasia, service providers and education working in partnership to provide long-term support for people with aphasia.(2009-09) Bixley, Morag; Rogers, J.; Woodfield, R.Item Open Access A small scale investigation in to the perceived effect of music on the quality of life for a person with aphasia.(2009-09) Belhaven, J.; Bixley, MoragBackground This small scale study was undertaken as part of the final year undergraduate degree programme at De Montfort University. In 1997 the Norwegian music therapist and author Even Ruud suggested that music was an intrinsic part of everyday life that supported health and wellbeing. The notion that aphasia rehabilitation should encompass more than the repair of language and communication has been supported by living with aphasia therapy advocates such as Lyon (2004) and Pound, Parr, Lindsay & Woolf (2000). This study was designed to investigate whether music function, music activity and music participation were thought to improve the quality of life of people with aphasia. Method 15 people with aphasia completed a twenty question music interview. The interview was divided into four dimensions. Within each dimension 5 questions were constructed that were designed to elicit information about each area: music function, music activity, music participation and perceived effect on quality of life. The questions in each section were derived from the concepts and vocabulary presented in WHO International Classification of Impairment, Activity and Participation (2002) and the Cruice, Worrall, Hickson and Murison (2003) Communication Related Quality of Life Model. Interview question presentation and response format was derived from the Stroke and Quality of Life Scale-39 designed by Hilari, Byng, Lamping and Smith (2003). Results were analysed statistically to evaluate significant responses to individual questions and significant relationships between dimensions. Results and Discussion Statistical analysis identified these significant results. The fifteen people who participated in the study reported that music evoked physiological and psychological changes. Music was perceived as a positive experience that was accessible to the fifteen people with aphasia despite the varying level of functional and physical restriction they experienced following their stroke. Finally statistical analysis revealed that music function was significantly related to perceived quality of life whilst music activity and music participation did not show a significant relationship to quality of life. The results of this small scale study suggest that the ability to include music in everyday life should be viewed as an accessible, beneficial and cost effective addition to the therapy tool kit of those who work alongside people with aphasia to help improve quality of life following stroke and aphasia.Item Open Access Sound cues are not always easier than meaning cues(2014-09) Naylor, S.; Bixley, MoragTITLE OF PAPER: SOUND CUES ARE NOT ALWAYS EASIER THAN MEANING CUES KEYWORDS: APHASIA, CUEING, TECHNOLOGY • WHY THE STUDY WAS UNDERTAKEN This work was undertaken as part of an undergraduate programme of study. People with aphasia (PWA) experience word finding difficulties (WFD). One of the aims of Speech and Language Therapy is to provide intervention to help PWA find words more easily (Royal College of Speech and Language Therapists, 2005). It is thought that the cueing hierarchy therapy technique (Rochford and Williams, 1962) may help PWA to access words more easily. Linebaugh and Lehner (1997) suggest that some cues are harder than others and that these cues should be used first, giving the PWA the opportunity to access the word with little external help. Easier cues should then be presented in descending order of difficulty until the PWA is able to find the word. Proponents of this therapy technique such as Thompson et al (2006), suggest that PWA are able to respond to sound cues more easily than they can respond to meaning based cues. This research project was designed to investigate whether people without aphasia have an inherent ability to use sound cues more readily than those based on meaning. • HOW THE STUDY WAS DONE 40 people agreed to participate in this research and were randomly allocated to either the meaning cue assessment condition or the sound cue assessment condition. In standardised computer administered assessments, the volunteers were asked to name 107 images of low frequency words. 57 of these images were objects or living things and the remaining 50 were corporate logos. After saying the word, the volunteer was asked to press the space bar to enable the next image to appear. If the volunteer was unable to find a word, cues were provided. In the meaning condition, a highly associated word was provided as a cue and in the sound condition, the first sound of a word was provided. These cues were given to try and stimulate word finding. If the participant was entirely unable to access the word, they were asked to identify the target word from a choice of three written words. • A SUMMARY OF MAIN RESULTS Results suggested that when participants were asked to find words for objects and living things, sound cues were more effective than meaning cues. Statistical analysis using Levene’s test of equivalence (p0.618) and subsequent t-test (p 0.00014) revealed a significant difference between the two conditions. This significant difference was not evident when participants were asked to name corporate logos. For this type of vocabulary, meaning cues showed a slight advantage over sound cues. • IMPLICATIONS FOR FUTURE POLICY AND PRACTICE The results of this research suggest that cueing hierarchies are dependent, not only on the client, but also on the concept selected as the target for therapy. Low frequency words and abstract concepts do not respond to cueing in the same way as frequent and imageable words. This has implications for the way in which therapists provide cueing therapy for PWA. This project also provides support and direction for the use of technology in the assessment and remediation of word finding difficulties for people with aphasia. • REFERENCES Linebaugh, C.W. and Lehner, L.H. (1997) Cueing hierarchies and word retrieval: A therapy program. In R.H. Brookshire (Ed.) Clinical Aphasiology Conference Proceedings. Minneapolis: BRK Publishers. Rochford, G. and Williams, M. (1962). Studies in the development and breakdown in the use of names. Journal of Neurology, Neurosurgery and Psychiatry, 25, 222-227. Royal College Of Speech And Language Therapists (2005) Clinical Guidelines. Bicester: Speechmark. Thompson, C.K., Kearns, K.P., Edmonds, L.A. (2006) An experimental analysis of acquisition, generalisation and maintenance of naming behaviour in a patient with anomia. Aphasiology, 20, 12, 1226-1244.