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A sign of things to come?

Speech & Language Therapy has always been the 'Cinderella' of the services within the NHS, historically, whenever there have been cut-backs to be made, the NHS bosses have known that it's an easy option. This is in, part due to the fact that the departments are mostly staffed by very nice ladies who wouldn't complain (or of they did, it would be 'ever so politely' and not very loudly). They know there would be little chance of strike action or industrial dispute. And who else would moan? Our clients have problems communicating their everyday needs, thoughts and wants, never mind be able to make a statement in support of the shortage of therapists. 

Yet, any communication difficulty, however small, can be devastating to the individual and have a major impact on the whole of that person's life. As I've put at the top of the blog, and can't say any better,‘The ability to communicate is central to all that we do, to who we are, how we learn and how we relate to others’ (Ross, Leeds Metropolitan University, 2007). Communication problems of any kind, however mild, will certainly lead to isolation, frustration and an inability to fully integrate into society. Children will have a harder time making friends and fitting into nursery or school while adults will have inummerable social, emotional and day to day difficulties.


Whether it's an adult who has suffered a stroke or a young child who is not developing language as they should, it is vital that they receive the help they need from suitably qualified, experienced professionals...I.E. SPEECH & LANGUAGE THERAPISTS. The Royal College of Speech & Language Therapists' Giving Voice Campaign is an excellent attempt to bring home the issues from the clients point of view. Unfortunately, this might have little impact in today's climate of cut-backs see http://www.northernireland.gov.uk/news/news-dhssps/news-dhssps-20102010-lack-of-funding.htm for what's happening in one area.


Am I falling into 'nimby-ism' (i.e. not in my back yard')? No, as I'm an independent therapist, who is likely to benefit from any NHS cutbacks. I am, however, a sad observer of what is happening to an essential service. I know speech, language and communication problems are not life threatening but they are thoroughly life impacting.

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Difficult to swallow!

An earlier blog post looked at Sumathi Sinnapan's vital-stim therapy. I want to look at her personal pioneering plight as she brings the practise to Britain.


Introducing anything new is always hard. People like familiar, tried and tested systems and methods in just about anything. However, the only way we can progress or move forwards is to make alternations, look for better alternatives and analyse what works.


One of the little known areas that speech and language therapists (SLTs) work with is dysphagia which is an inability to swallow. This means all eating and drinking could be banned to prevent life-threatening choking.
Imagine if you had a head injury (which could happen at any time!) or stroke, which made normal eating or drinking impossible. How would it affect  your social life, could you still go to restaurants, bars, pubs? What would you do at the theatre or football match during the break? Family life would be completely changed too; no Sunday lunches with everyone round. You would probably just want to avoid food and drink situations all together.


Vital-stim involves electro-muscular stimulation administered by a speech and language therapist. This is usually the domain of physios but they only go as far as the neck and don't study the larynx. SLTs on the other hand spend hours studying the larynx but they don't traditionally use muscle stimulation techniques. This is the problem; the SLTs governing body The Royal College of Speech & Language Therapists have not been persuaded by the trials so far, despite an apparent wealth of evidence from the US and Asia to support it as a method.


Sumathi came across the principle while working in Asia, she looked into it and decided it was extremely convincing.


Sumathi has her work cut out to enable patients to be able to add this therapy as a choice to treat their dysphagia and to make Vital-stim a natural option for clinicians. She has a steep hill to climb but with something so important it's essential she carries on despite many set backs so far. She has invested a great deal of time, money and personal reputation. I wish her every success!!

For more information: www.vitalstim.co.uk 

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• Dysphagia found to increase length of hospital stay and mortality risk (eurekalert.org)
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Nearly one in six children - and almost one quarter of boys - have difficulty learning to talk, research suggests.

A YouGov online survey of 1,015 parents found only half of children with speech problems received expert help. The survey, for England's first "Communication Champion" Jean Gross, found some three-year-olds were unable to say a single word. Ms Gross said the proportion of children with problems is "high" and that getting help early was essential. "Our ability to communicate is fundamental and underpins everything else. Learning to talk is one of the most important skills a child can master in the 21st Century," she said. Click to play Click to play "The proportion of children who have difficulty learning to talk and understand speech is high, particularly among boys. "It is essential that all children get the help they need from skilled professionals as early as possible." Six out of 10 people questioned for the survey said the ability to talk, listen and understand was the most important skill for children to develop in the early years. This priority came ahead of the ability to interact with others (26%), reading skills (11%), numeracy skills (2%) and writing skills (1%). FIRST WORDS Dada - 15% Daddy - 13% Mama - 10% Dad - 10% Mummy 8% Mum - 7% Cat 2% No - 1% Dog - 1% All those questioned said they looked at picture books with their children, told them stories and sang nursery rhymes with them - all activities which boost language development. The survey showed that the majority of children (51%) did not enjoy looking at picture books with their parents until they were over six months old, but 18% enjoyed this at three months or younger. Children from more affluent families were reported to enjoy looking at picture books, and listening to stories and rhymes, at a younger age than children from less affluent families, researchers said. First words The most common age for children to say their first word, according to the parents surveyed, was between 10 and 11 months. More girls than boys (34% against 27%) said their first word before they reached nine months. But 4% of children had not said their first word by the age of three. There were no real social class differences in when children said their first word, the researchers said. Most parents (95%) could remember what their child's first word was. Among those surveyed, that word was most likely to be "Dadda" (15%) or "Daddy" (13%), with "Mama" (10%) and "Mummy" (8%) trailing a little behind. Speech experts generally think the "da" sound is easier for babies to say than "m". The YouGov research involved 1,015 parents of children aged one to to seven, questioned online in December. The figures have been weighted to provide a representative sample. Tweet

S & L World: a global bulletin for SLT/SLPs published by Small Talk SLT Ltd

I've been truly fascinated by following Speech & Language Therapists (they're called Speech & Language Pathologists in many parts of the world) on Twitter and Facebook. As I blogged before, I've actually had conversations with some of the people I've read about. I've been inspired and had my ways of thinking both challenged and confirmed.


I was discussing with my partner Ray, who suggested that it would be a great idea to have a magazine full of articles from around the world all about speech and language therapy/pathology. He had the means and skill to do the website and the technical know- how to make it happen........that was last week and anyone who knows me (or him), knows we NEVER hang about on a  good idea so 'S & L World' first edition will be out to co-incide with the UK Year of Speech, language and communication.

I've already got people I admire writing articles for it. 


Once the first edition is out we can do a marketing campaign, using the magazine to really get people interested. I'll invite all the UK PCTs, ASTIP members and the British Universities to take part plus our counterparts in Canada, Australia, New zealand, UAE, Cambodia.... everywhere that you'd have our profession. There are 11,500 in the UK alone. It's a great CPD opportunity (especially for me as I'll be able to read all the submissions!).


It will be a chance to share examples of good practise, discuss what works, look at specific issues and general trends.


Anyone who wants to contribute after the first issue, will have to be a subscriber, with discounts for students and retired therapists. I'm really excited!!


Please e-mail info@smalltalk-ltd.co.uk if you have anything you would like to have considered for inclusion. The deadline for the first edition is the end of November.

Tweet  like us on facebook http://www.facebook.com/pages/S-L-World-A-global-bulletin-for-SLPSLTs/112157878847806

A total disaster??? Not really!

I was really excited last week as some people from Singapore were coming to observe the groups at one of the local Children's Centres with a view to having a franchise in Singapore. We had been liaising for months about how the groups worked and what the reasoning behind them was etc. They had had video and sessions plans as well as the franchise agreement. I never 'count my chickens' as it were but I was very hopeful. They were, after all, coming all the way from Singapore!!


On the morning of the visit, I had everything laid out and planned with notes for them to follow so they could see what I was doing and why, in a smart presentation pack.


The first group is for 3 year olds to prepare them for school. A group of 6 children came in and everything went to plan....... for 10 minutes, then there was a loud bang as a Father and his 2 year old toddler loudly burst into the room. The father sat down and left his young son to his own devises. He just gave a running commentary about how naughty he was. He then made himself a coffee and gave his son a biscuit from the kitchen, 'to shut him up'! I continued with the group as best as I could, given the huge distraction the man and his son posed to the young children who were trying to do their best to concentrate.


The people from Singapore had obviously never met someone like this man: vest top with numerous tattoos, missing teeth ........ you get the picture! The clash of cultures was almost audible!


The little boy was gorgeous but had only grunts as his means of communicating. His attention span was so short he couldn't sit down for more than 20 seconds. We muddled through the first group as best we could. The next group is for 2 year olds, so was ideal for the little boy. The parents sit on the floor to encourage their little ones to take part. We work on eye-contact, turn taking, sharing, co-operation, attention, listening and vocabulary before the songs, story, bubbles and snack time. Unfortunately his father didn't join the group or retrieve the little boy every time he ran into the toilet which he did every few minutes. The session was, therefore, dominated by me having to get him out of the toilet area,  prevent him from posting things down the toilet  and generally keep him safe from harm. The other mothers were great and kept trying to involve him with the activities. Another mother did the activities while I was otherwise occupied!


The visitors appeared horrified and somewhat traumatised as the father then told them repeatedly, in front of his child about the horrifying drunken antics of the child's mother over the years. At the end, he just wouldn't leave and his level of conversation completely deteriorated! It was quite frankly a complete disaster in terms of 'selling' the groups. The visitors made their excuses and left!


However, the little boy and his dad are exactly the sort of family that I want to work with in the children's centres. I know that we can do wonders with the little boy and show his dad how wonderful an achievement language really is. I'll set ground rules and discus what we're trying to achieve and why, with ideas to try at home. They are typical of many families these days, where parents just don't know how to interact with their children. They are doing the best they can in stressful circumstances. They are feeding and clothing their little ones but don't know they should be listening to and talking with them. This is creating thousands of children a year who have speech, language and communication delay for no other reason that they are not receiving sufficient stimulation. Without intervention, they start school at a disadvantage and this gap is often not closed by the time they leave. There is frightening evidence  to show that the standard of living for these young   people and their expected long term socio-economic outlook is poor. This is the whole reason why early intervention is necessary and why I set up the Smart Talkers groups.


So, it was a disaster in terms of the people from Singapore but I know that ultimately, I'm there for little boys and girls like this one and that is much more important than selling franchises to Singapore or anywhere else! 

There'll be other opportunities but the little boy needs a chance more than anything.

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Tips for Talking from I CAN

"In the same way as your child does not learn how to walk straight away, he won’t know how to talk straight away either. He will, however, spend much of the time in his first few months, weeks and even days preparing for his first words. Communicating orally is a highly developed skill which depends on a range of abilities - the ability to understand the words being used by others; being able to think of the right word and put it into a sentence correctly; and being able to make the sounds necessary to form words. All of these skills rely on a whole set of underlying abilities that most children start to develop from the moment that they are born.
The stages of communication development are the same the world over and all children rely on those around them to help develop the skills of communication. As a parent, you will have a key role in helping your child to talk. The parent section of the talking point website (www.talkingpoint.org.uk) is full of hints and tips to help you when your child is learning to talk. There are many other useful factsheets, books, articles and programmes (some of which are listed below). This factsheet helps you with the basics – what you need to do to help your child communicate. The tips here will be useful to your child whatever their age and whether or not they are communicating at the same level as their peers:
Here are the tips:
• For young children, have fun with nursery thymes and songs, especially those with actions.
• Encourage your child to listen to different sounds such as cars, animals, the telephone
• Imitate the sounds you hear, make funny noises for your child to copy. This will help awaken an interest in sounds and help your child to understand that sounds have meanings
• Gain your child’s attention when you want to talk together. It is better to say “Ryan, please come over here”, than to say “Come over here, Ryan” because then your child will be focussed once you call his name
• Encourage your child to communicate in any way, not just through words, Actions and gestures will all help to develop words
• Listen carefully to your child and give him time to finish. Take turns to speak
• Always respond in some way when your child says something – no matter what it is that he says
• Spend some special time with your child every day. The level of talking will depend on the age of your child. Talk together when you are playing, or talk about school or make plans for the future.
• Allow plenty of gaps around the sentences that you are using to your child. This will allow him time to think about what you have said and maybe to formulate a response
• When talking with your child, use sentences that are roughly one word longer than the sentences your child uses.ie. if they are using one word, you use two; if they are using four, you use five. This will help extend your child’s sentences as they can hear what the sentence structures for longer sentences are like.
• If your child says something incorrectly, say it back the right way rather than “correcting him”. Eg. If your child says “Goggy bit it”, you can say “Yes, the dog bit it, didn’t he?”. He is more likely to change what he says in the future when he has worked it out for himself.
• When talking to younger children, try and think about how you are talking: use short sentences, vary the melody for interest, slow down slightly and pause after each sentence.
• Try to make TV time shared time – sit down with your child to watch programmes that are for children of his age".
More information is available in -
“Baby Talk : Strengthen Your Child's Ability to Listen, Understand, and Communicate “ by Sally Dr Ward Published by Ballantine Publishing Group (2001) ISBN: 0345437071;
“Listen to Your Child: A Parent's Guide to Children's Language” by David Crystal Publisher: Penguin UK; New Ed edition (June 1999) ISBN: 0140110151
“Chatterchart – a family guide to children’s communication development” Available from I CAN

Smart Signing in Nurseries & Early Years

What is Smart Sign? 

This is based upon Makaton supplemented by BSL where necessary. Our programmes are designed to work on essential interaction and communication skills. All our programmes are developmentally based and are written by me, Libby Hill, a Specialist Speech and Language Therapist with advice from colleague, Franky Shepperson a Highly Specialist SLT who is fluent in BSL and Makaton.  They have been piloted and thoroughly evaluated before being used extensively in nurseries and also with children with communication delay including children with ASD. We are also developing a programme for use with bi-lingual children.

Baby Smart Sign

In nursery the group leader will sit with staff and babies and sing interactive songs. Turn-taking, attention, listening, eye-contact and recognising their own name are all important aims of the session.

There will be opportunity to discuss signs around the baby room and how to add sign to everyday commands e.g. ‘Shall we change your nappy?’, ‘It’s time for lunch’.

Toddler Smart Sign

This involves teaching the 2-3 year olds simple vocabulary from a 6 week programme in a circle-time style. This is topic based, as evidence shows they learn vocabulary more effectively this way. We have some songs and a story to follow the topic. The aims here include attention, listening, turn-taking, eye-contact, receptive skills and vocabulary development. The main aim is to teach the staff signs so they can supplement understanding.

Pre-School Smart Sign

This age group just love learning the signs so the vocabulary for the topic can be taught directly and they will be highly involved in signing to the adults. There is still room for a story and a couple of songs. Aims here include attention, listening, receptive language and expressive language skills, as well as eye-contact.

Smart Sign in Reception & KS1

A programme of vocabulary which the children learn to sign as well as to understand. We use stories and songs too. The aims are to aid receptive and expressive skills as well as narrative.

We can also do specific sessions for parents or staff.

For more information: www.smarttalkers.org.uk

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The power of the blog

I wasn't sure when someone suggested doing a blog. I couldn't see why the news section on my websites weren't sufficient. After all, I also added it onto both the Small Talk Speech Therapy and Smart Talkers Pre-School Groups Facebook pages. I didn't think I'd have time to blog with FaceBook and Twitter too, there are only so many hours in a day.


However, Ive just e-mailed the person who originally recommended it, Carol Garrington from Passionate Media*. I usually just do whatever she suggests, as she is an expert in her field and always knows what she's talking about. I've apologised for ignoring this part of her advice until June this year.


It's fantastic! Firstly, I've really enjoyed doing the blog. It's quite indulgent really, writing or reporting about topics about which I'm passionate. I can write whatever I want with the rider that its my own personal opinion, it's been great fun so far and has felt more like a hobby than work. Once I realised it could be graded, I wanted to make at least 50!


I've also had so much interaction from people I have observed from afar, experts in the field of speech, language and communication or child development. I have shared personal views with people for whom I have a great deal of admiration and respect.


It's a really effective way of reporting about what I feel are vital issues and letting people know what we're doing. I know we're carrying out fascinating, varied projects so its great to be able to tell the world.


By the world, I mean that literally. The blog has been the way I've come to the attention of international followers. Consequently, I have a lady from Singapore coming on Thursday to see my groups as she would like to have a  franchise in Singapore and a lady from Delhi who wants to be master franchisee for India.

I've tied it into Twitter and  Facebook to really maximise the social media marketing opportunity. So if anyone is thinking of blogging but can't see the value..... please see me!






*Carol Garrington runs courses on how to make social media marketing work for you carol@passionatemedia.co.uk


If you want to see example of how I tie it into Facebook http://www.facebook.com/pages/Hednesford-United-Kingdom/SmallTalk-Speech-Language-Therapy/209724150244?ref=ts and http://www.facebook.com/pages/Smart-Talkers-Pre-School-groups/126998813993019?ref=ts

Speech and Language Therapist? What's that then??

We had a local group meeting for the association of speech and language therapists in independent (ASLTIP) practise last night. We had decided to have 3 presentations about 3 different aspects of our work. Christine Charles discussed a case of severe stammering, Franky Shepperson reported on ASD from a parent's and professional perspective and Sumathi Sinnapan shared her quest to have vitalstim therapy recognised in the UK.

What occurred to me most was that all three women were completely passionate about what they did. They are skilled, knowledgeable and expert in their field. It also reminded me of how fantastic  it is to be a speech and language therapist. Human communication is one of the most wonderful achievements and to be able to study it and use the knowledge gained to assist people is really a privilege.

Unfortunately in a busy, over stretched NHS, we easily forget this! It also means we tend to keep quiet about what we can do. I thought a reminder was needed, this is taken from the Royal College of Speech and Language Therapists website:

Speech and language therapy is concerned with the management of disorders of speech, language, communication and swallowing in children and adults. Speech and language therapists (SLTs) are allied health professionals. They work closely with parents, carers and other professionals, such as teachers, nurses, occupational therapists and doctors. There are around 11,500 practising SLTs in the UK.  

They work in:

·         Community clinics

·         Hospital wards

·         outpatient departments

·         mainstream and special schools

·         children's centres

·         day centres

·         clients' homes

·         courtrooms

·         prisons

·         young offenders' institutions

·         independently/in private practice

Speech and language therapists work with:

Babies with:

·         feeding and swallowing difficulties

Children with:

·         mild, moderate or severe learning difficulties

·         physical disabilities

·         language delay

·         specific language impairment

·         specific difficulties in producing sounds

·         hearing impairment

·         cleft palate

·         stammering

·         autism/social interaction difficulties

·         dyslexia

·         voice disorders

·         selective mutism

Adults with

·         communication or eating and swallowing problems following neurological impairments and degenerative conditions, including stroke, head injury, Parkinson's disease and dementia

·         head, neck or throat cancer

·         voice problems

·         mental health issues

·         learning difficulties

·         physical disabilities

·         stammering

·         hearing impairment

How can I become a Speech & Language Therapist?

All speech and language therapists must complete a recognised three- or four-year degree course and register with the Health Professions Council before being able to practise. The courses combine academic study and practice/clinical placements.

Most courses require three A-level passes or five Scottish highers as minimum entry qualifications. Some courses require specific GCSE and A-levels, such as English and biology, so check the entry requirements with each university.
The practical components of the courses are very important. These may take place in schools, NHS hospitals and community health clinics and are designed to develop skills in assessing and treating people with communication disorders.

For more information contact the Royal College of SLTs  on www.rcslt.org or http://www.nhscareers.nhs.uk/details/Default.aspx?Id=288  For more about Small Talk Speech & Language Therapy www.private-speech-therapy.co.uk