School of Allied Health Sciences

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    ItemOpen 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.
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    Communication confidence in different settings: perceptions of nineteen people with aphasia
    (2013-09) Hayward, K.; Bixley, Morag
    Communication 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.
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    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.
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    Happiness and aphasia groups
    (2014-09) Cowles, H.; Bixley, Morag
    TITLE 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.
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    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.
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    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, Morag
    Background 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.
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    Sound cues are not always easier than meaning cues
    (2014-09) Naylor, S.; Bixley, Morag
    TITLE 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.
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    Ward based feeding and swallowing training.
    (2014-09) Bixley, Morag; Blagdon, B.; Forknall, N.; Bird, L.; Hood, G.; Gutteridge, K.
    TITLE OF PAPER: WARD BASED FEEDING AND SWALLOWING TRAINING KEYWORDS: DYSPHAGIA, EVIDENCE BASE  WHY THE STUDY WAS UNDERTAKEN This paper summarises the findings of the Northamptonshire Healthcare (NH) Feeding and Swallowing Training programme initiative. The results of the pilot study for this programme were presented at the Royal College of Speech and Language Therapists Conference in 2012. Speech and Language Therapists (SLTs) in the acute setting spend half of their time involved in providing feeding and swallowing care (Bixley, Blagdon, Dean, Langley & Stanton, 2011). As part of the multidisciplinary team, the overall aim of feeding and swallowing intervention is to help clients to meet their nutritional need. A recent Care Quality Commission (2011) report suggested that 51% of hospital trusts were not achieving this standard. Hospital based policies such as protected mealtimes highlight the importance of feeding within the acute sector. Inter professional guidelines (Boaden, 2006) and the evidence base for dysphagia management (Magnus, 2001) also support the use of specific feeding and swallowing training. However delivering comprehensive training within large hospitals is difficult using classroom based packages. Especially in environments where ward teams are large, staff teams change regularly and releasing staff for off ward training is difficult. The Northamptonshire feeding and swallowing programme was introduced to provide a sustainable swallowing training package that could overcome some of these difficulties, by providing training to nursing staff on the ward  HOW THE STUDY WAS DONE The NHSLT team evaluated the impact of their innovative feeding and swallowing project by comparing the results of three ward based measures: B1, B2 and B3. The research was carried out on four acute wards, one after another. It was conducted during the hospital wide, one hour protected lunchtime slot. In each of the wards observational and questionnaire measurements (B1) were taken before implementation of a two week, eight day, training package. After the ward based training had occurred two further evaluations were conducted, one immediately after the training package had been delivered (B2) and one two weeks after the programme had been completed (B3). Observational measures were qualitative and recorded general impressions of the feeding practise on the ward. Questionnaire measurements were both quantitative and qualitative and were designed to identify what ward staff understood about feeding and swallowing difficulties.  WHAT WAS FOUND Over the course of the ten month research project, twenty four hours of training was provided for fifty four people, on four different wards. Training was provided to 31 health care assistants, 17 nurses, 3 student nurses and 2 assistants and 2 others .Statistical analysis of the ward based knowledge questionnaires suggested that there was a significant difference between the scores obtained in B1 and B2 and B3 (Kruskal Wallis H (2) = 15.537, p=0.014 with a mean rank of 18.64 for B1, 34.83 for B2 and 37.78 for B3). These findings suggest that the feeding training programme had resulted in a measurable difference in ward staff knowledge and this difference was evident after the training programme had been completed.  IMPLICATIONS FOR FUTURE POLICY AND PRACTICE The results of this study suggest that ward based feeding programmes are an effective way to deliver training. This type of training targets people who do not normally attend swallowing training courses because they cannot be released from their work. It also means that training can be individualised to the needs of different wards and staff members. This type of training delivery may be a valuable supplement or alternative to classroom based teaching programmes. • REFERENCES Blagdon, B., Bixley, M., Levis, N., Bird, L., Hood, G. & Murphy, K. (2012). Taking dysphagia management out of the classroom: A ward based feeding and swallowing project. Royal College of Speech and Language Therapists Conference, Driving transformation Using Evidence Based Practice, 52. 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. Boaden, E. & Davies, S., Storey, L., & Watkins, C. (2006). Interprofessional Dysphagia Framework. www.uclan.aca.uk/facs/health/nursing/research/groups/stroke Care Quality Commission (2011). Dignity and Nutrition Inspection Programme. Newcastle upon Tyne: Care Quality Commission. Magnus, V. (2001). Dysphagia training for nurses in an acute hospital setting – a pragmatic approach. International Journal of Language and Communication Disorders, 36, 375-378.
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    What do untrained conversation partners know about communicating with people with aphasia?
    (2009-09) Mallender, T.; Bixley, Morag
    Background This study was undertaken as part of the final year undergraduate degree programme at De Montfort University. In 2006 Turner & Whitworth identified that teaching conversational partners about supportive communication strategies was a key theme of the three main approaches to conversational therapy; the conversational analysis approach, the supported conversation approach and the conversational coaching approach. This research project was designed to investigate whether potential conversation partners who had not received conversational partner training could identify ways to support conversations with people with aphasia. The results of this investigation may help to inform speech and language therapists about what prospective untrained conversational partners may know about supporting communication with people with aphasia. Method 30 people participated in this small scale study. Participants were asked to look at a DVD clip (Kagan, Winckel, & Shumway (1996)) of a doctor interacting unsuccessfully with a person with aphasia. After seeing this unsuccessful interaction the participants were asked to complete two measures designed to assess knowledge of supportive conversational strategies. For the first knowledge measure participants were asked to think of ways to support conversations with people with aphasia and write these onto a blank mind map. For the second knowledge measure participants were asked to complete the Rayner & Marshall (2003) communication strategy identification questionnaire. Results The mind map knowledge measure elicited 17 communication strategies that participants thought might support a conversation with a person with aphasia. Some strategies were thought to be less helpful than others. The responses to the second measure, the Rayner & Marshall (2003) strategic questionnaire, showed that participants were able to differentiate between supportive and unsupportive strategies with 75% accuracy. Discussion The results of this small scale undergraduate study suggest that people who volunteer for conversational partner training may have quite detailed knowledge about how to support conversations with people with a aphasia before undergoing training. The responses elicited in the study suggest that the blank mind map technique and the Rayner & Marshall (2003) strategic questionnaire may be used to gauge the prior knowledge of conversational therapy trainees before conversational therapy begins.. References Kagan, A., Winckel, J. & Shumway, E. (1996). Supported conversation for aphasic adults: Increasing communicative access. DVD. Toronto: Aphasia Centre, North York. Rayner, H. & Marshall, J. (2003) Training volunteers as conversation partners for people with aphasia. International Journal of Language and Communication Disorders, 38, 2, 149-164. Turner, S. & Whitworth, A. (2006) Conversational partner training programmes in aphasia: A review of key themes and participant roles. Aphasiology, 20, 6, 483-510.
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    What so service industry workers know about people with aphasia? – a small scale questionnaire investigation.
    (2009-09) Larter, C.; Bixley, Morag
    Background This study was undertaken as part of the final year undergraduate degree programme at De Montfort University. In 2003 Code found that people with aphasia (PWA) spent an average of twenty hours outside their home in a typical week. In this time PWA talked to family friends and service industry workers. Research by Brown, McGahan, Alkaledi, Seah, Howe & Worral (2006) conducted using two small focus groups described the difficulties people with disabilities encountered when they were shopping. Brown et al’s (2006) study concluded that attitudes to disability and a lack of knowledge about different types of disability were barriers to the social participation of people with aphasia (PWA). These studies prompted this research question: What do service industry workers know about people with aphasia? Method The questionnaire used in this study was based on the interviews conducted by 2003 Simmons-Mackie, Code, Armstrong, Steigler & Elma in 2002. Simmons-Mackie et al’s (2002) survey questions had identified that members of the public across three continents had very little understanding of aphasia. Fifty service industry workers from one retail outlet of a British national chain of shops were asked to complete the adapted questionnaire about their understanding of aphasia. Results 31/37 84% service industry workers were unable to provide any information about aphasia. 37 questionnaires were returned. 6/37 (16%) of service industry workers were able to describe aphasia. These 6 retail assistants also knew that strokes and head injuries resulted in aphasia and were able to identify helpful strategies to aid communication with a PWA. The six service industry workers attributed their knowledge of aphasia to personal experience, listening to the radio or watching television. Discussion This small scale study has provided more evidence to support the position that service industry workers may have very little understanding of the communication difficulties experienced by PWA. The results of this study could be used to support the argument that speech and language therapy intervention packages should promote more strategies to overcome the difficulties PWA may encounter when communicating with service industry workers such as retail assistants, policemen, civil servants and transport employees. References Brown, K., McGahan, L., Alkhaledi, M., Seah, D., Howe, T. & Worrall, L. (2006) Environmental factors that influence the community participation of adults with aphasia: The perspectives of service industry workers. Aphasiology, 20,7,595-615. Code, C. (2003) The quality of life for people with chronic aphasia. Neuropsychological Rehabilitation, 13, 3, 379-390. Simmons-Mackie, N., Code, C., Armtrong, E. Steigler, L. & Elam, R. (2002) What is aphasia? Results of an international study. Aphasiology, 16, 8, 837-848.