Beyond Words

So as the snow came falling, just before my last clinical placement begins, I took the opportunity to relax and chose a movie from my ‘to watch’ pile of DVDs.

Have any of you watched the movie, Eat Pray Love, starring Julia Roberts? A not-so-typical drama/romance, Eat Pray Love is about a married woman’s journey round-the-world to discover herself after a painful divorce. I can go on and on about the movie and don’t want to accidently spill spoilers for those of you that haven’t watched it.

You’re probably wondering what this has to do with speech therapy. Well, there was this scene in the movie where they were discussing learning the Italian language, saying “You don’t speak the language with just your mouth, you speak it with your hands”. Naturally, as an SLP2b, I began to notice and analyze all the gestures in the movie and found it fascinating that one can interpret so much of what is being said just by looking at gestures.

I managed to find this part of the movie on Youtube, and thought I’d share it (no spoilers here!)

Most people link gestures to people who are deaf  or struggle with a communication difficulty, but gesturing is natural and everyone uses these great, clumsy appendages at the end of our arms – our hands!

Some reasons why people gesture:

1.     It helps them be more fluent and articulate. A study involving three groups (both arms immobilized, one arm immobilized, and free to gesture) concluded that dysfluency increases as gesture is restricted.

2.     It conveys enthusiasm, confidence, and passion

3.     Helps clarify the message

There are several types of gestures. Conventional gestures are gesture-symbols like the ‘thumbs-up’ or ‘okay’ gestures.  Iconic gestures have meanings too, but they aren’t symbolic.  So these are often the gestures you make without thinking about it when you are talking, like gesturing backwards over your shoulder when you say things like “I was at my friend’s house yesterday …” The meaning in the gesture echoes some of the meaning in what you said.

Gestures & Communication Difficulties

A patient group that uses a lot of gesture to communicate is people with aphasia. It is great that, although they may not be able to access the words they want to say, they may be able to gesture some of them. Interestingly though, people with aphasia might sometimes have the same problems with gesture as they do with language.  Let’s say someone cant quite get the word ‘bird’ and they say something like ‘ooh the p .. the little one there … the p.. the b.  the um that one’,  research has shown that sometimes the gesture will stuck in a similar way too.  A study by Dr Lucy Dipper looked at a narrative told by a lady  with aphasia, and showed that the gesture she used could give us useful clues about her language impairment. To find out more about the patterns in this lady’s gesture, access the paper here.

So guys, next time you are on a bus journey/train journey back and forth to uni/work, take a look at those around you and see how natural it is to use gestures. I am going to set a challenge. Turn your music up loud and take a look around, see if you can work out what others are saying without being able to see or hear their words? Let me know how successful you are!

The use of BSL

Also, did you realize that British Sign Language (BSL) is an entire language, just as complex as English and Arabic, composed of hand movements only?  BSL is used by a range of people, such as the Deaf, and teachers and family members of deaf people. An estimated number of 125,000 deaf adults and 20,000 children use BSL in the UK. It involves the use of signs, facial expressions, body movements, and space to communicate.  The signs are different from gesture because they are completely symbolic and so you can’t usually guess what they mean if you don’t sign yourself.

BSL has its own system of complex grammar and phonology, which is defined by orientation, location, hand shape, motion and so on…Although it may appear to be very different than spoken language, the child processes of phonological acquisition of BSL and speech development are similar. Actually, a very interesting study (click here to access for free) was conducted by one of the professors at our university, Dr. Gary Morgan, on a deaf little girl.  Her sign language used the same kinds of simplification strategy as you would expect in the speech of a hearing child.

I’ll leave it at that for now, as I can go on and on about the wonders of expanding communication beyond the use of words!

Hope you enjoyed this month’s blog, see ya!

Love,

Dana

Consoling Emotions

Happy Holidays everyone! I hope you are all having a fab time with your loved ones, making lots of new memories x 

As the end of the year is approaching, it finally hit me: my studies are nearing its end! That is when I decided to face the dreaded pile of papers that need to be filed and organized. Sigh.

Sleeves up, hair in a bun, Red Bull in one hand and a hole-puncher in the other; I was ready. I must admit, although some bits of organizing my papers were as dreadful as I thought, there were moments of laughter, awe, and fulfillment rummaging through old reflective logs, feedback, and coursework.

I came across a reflective log I wrote about an experience I had in my first placement, which was at a neurological rehab ward. Reading the log, I realized how terrified I was at the point. It was about a session I had with an ambitious and determined 45-year-old lady who suffered from a stroke and was just told that she will not be able to go back to her dedicated job as a solicitor.

I remember feeling helpless and useless while watching her shout, laugh, and cry at the same time. I was also frightened that she’d throw something at me as she dropped everything on the counter onto the floor. At the same time, I had gone mute. I was not able to console her with anything calming or nice, as if I swallowed my tongue. I did not call anyone because I sensed that she needed to let it all out and have someone listen.

I remember leaving that room in complete shock, and the first thing I wanted to do is write about it. Reflecting on the session, I realized that I was unable to support her.

Have you ever thought about the role of counseling in speech and language pathology?

SLPs very commonly work with patients or carers who may be dealing with denial or grief. They may be tearful during a session, unable to engage in therapy, demonstrate strong emotions, or simply tell us they’re feeling low. They may also be struggling to adjust to their or their spouse’s/children’s difficulties at home and share this with us during the appointment. This is when our skills in counseling are crucial. Not only does it comfort the patient, addressing these issues may also allow therapy to follow on more effectively.

"Feelings are a large part of the communication process…." (Aronson,1990)

For example, people with aphasia make up a large proportion of our caseload, and research has proven that their condition affects their quality of life. Dr. Katerina Hilari conducted a study that concluded that people with aphasia reported worse quality of life post-stroke in comparison to those without aphasia, participating in fewer activities. You can access this research for free here to find out more.  As a result of this deteriorated quality of life and major change to their typical life pre-stroke, it is inevitable that you will come across some sessions with your patients with aphasia, in which they will complain about something they can’t do anymore, feel low, and not respond to therapy. The counseling skills associated with managing such situations is a fundamental part of the role of a speech therapist.

Counseling ‘focuses on the individual’s self-growth, encourages the person to make his or her own choices and to take responsibility for them’ (Brumfitt, 2010)

Who may need counseling?

Anyone. Most of the patients attending therapy will have some sort of communication or swallowing difficulty, and lots of difficulties can arise because of this in their social and personal life.

Keep in mind that your responses need to be appropriate for their level of understanding. Counseling skills may also be needed for children with communication difficulties and adolescents experiencing difficulties in school (e.g. bullying, loneliness).

A study on emotional health by Dr. Nicola Botting demonstrated a higher rate of anxiety and depression in adolescents with SLI, and therefore, they may be one of the common cases in need of counseling. To find out more about the study and the responses of the participants with SLI to mood questionnaires and anxiety scales, click here.

                                              VALUABLE COUNSELING SKILLS

1. Empathy – sensitivity to patient’s feelings and ability to demonstrate understanding verbally (not silently) in response to their feelings.

2. Acceptance

3. Warmth

4. Respect

5. Acceptance

6. Genuineness

7. Setting up a suitable environment (time/privacy/ethics/safety)

Counseling tips

1. An important tip for your own wellbeing – You are not expected to ‘fix’ things. You are not responsible for what’s going wrong, and you do not have to stress about finding a solution. Adapting the skills of an understanding, responsive, comforting, and sympathetic listener is what is expected of your role as a speech therapist.

In a recent tutorial at university, our tutor, Dr. Madeline Cruice, was sharing an experience with a descriptive study she had done on exploring how people with chronic aphasia describe their quality of life (positives and negatives). You can access her paper for free here too (interesting read!) Anyways, her research methodology involved interviewing around 30 participants with aphasia and asking them questions like “What things take quality away from your life?” and “What would make the quality of your life worse?” Madeline told us that this involved listening to a lot of upsetting circumstances and tears, and it would have been emotionally draining if she were to feel responsible for fixing all their hardships.

2. The patient may feel comfortable talking to the therapist about lots of issues. If a serious issue was raised during the session that you think will affect the patient’s health or wellbeing, someone who can handle the situation better should be consulted, such as a doctor or a counselor.

3. Use body language to show sympathy (e.g. nodding, facial expressions…)

4. Sometimes a full session may need to be dedicated to counseling. Let it be. It will probably improve the patient’s mood and attitude, allowing therapy to follow on more effectively.

5. Do not put yourself in their shoes. Understand the person’s perspective and point of view. 

Thanks for reading everyone! Keep an eye out for my upcoming posts :)

For those of you who are speech therapists, I hope this post has helped you have a better perspective in counseling in our field and what is expected of you!

And for those of you who aren't speech therapists, these skills are still relevant, valuable life skills. You are bound to be kept in situations with friends and family, or even at work, where someone pours their heart out to you, and it is important to consider your response, as they are very vulnerable at that point!

Enjoy the rest of the holidays and Happy New Year in advance fellow readers! 

Dana xx

The Breakdown of Language

Austin

So the other day I was struck when I read an article on The Record about a stroke survivor with aphasia, Austin, who is determined to help other patients with language disorders. “If I’m going to be limited to what I can do personally, then I may as well try to help,” said Austin, whose life has radically changed by a stroke, motivating him to start a a support group for those suffering from devastating conditions. Aphasia is a communication difficulty that is acquired by many stroke survivors and its symptoms range from having difficulty naming words to being unable to speak, read or write. Austin was in his early 40s when he suffered from a stroke and his loss of communication abilities was serious. Although, with tremendous effort, he’s made improvement, he still struggles. “It’s like identity theft and I deal with it every day,” he said.

Austin came up with the concept of an Expressive Café, as the best way to help people to recover from aphasia. It’s a really cool way to get survivors together and have them engage in conversations.

Have a look at the following eye-opening winning video of the Brain Awareness Video Contest to have a better understanding of how Aphasia can affect someone: 

“Treasure Hunt” by Shiree Heath, University of Queensland`, Australia

Austin mentions, “[Stroke survivors] are home alone with no social engagement and not a lot of opportunity to just get out to talk,” and it is inevitable that this may have an impact on the quality of life of people with aphasia. I have seen this first-hand, as an uncle of mine, previously a language professor in Morocco, suffered from a stroke many years ago and acquired chronic aphasia, which affected his social life and quality of life immensely. Today, he is in a state of severe depression, refusing to leave the house or to allow us to visit him.

I found this article by Dr. Katerina Hilari, a lecturer at City University London, who did an interesting study looking at the long-term effects of a stroke on the quality of life of people admitted to acute stroke units. She compared the outcomes of people with aphasia and people without aphasia and found that those with aphasia were more severely affected. To find out more about how they were affected, you can check out the paper for free here.

You may be wondering what ‘quality of life’ actually means for a person with aphasia, and how it is measured. Although there’s an increasing need for therapists to consider the patient’s quality of life in order to provide successful intervention, there is very little research focusing on the people with aphasia’s perception of their own quality of life. This also got me thinking, so I found this where, Dr Madeline Cruice and others took an interest in conceptualising people with chronic aphasia’s view of their quality of life. They found that the core factors for the quality of life of the participants were verbal communication, body functioning, and activities. Other aspects included home, health, personal outlook, and independence. These factors could either improve or deteriorate their quality of life. To learn more about this study, click here for open access.

So yeah, although people with aphasia’s speech may be compromised, it doesn’t mean that they have no means of communication at all. Many people have the misconception that communication is in the forms of speech only. However I think it’s really important to understand that, communication can occur in many forms and manners, such as facial expressions, body language, and gestures. It is natural for gestures to accompany speech even with people with typical speech and language (e.g. thumbs up). Evidence suggests language influences the type of gestures used. An interesting research has been conducted by Dr Lucy Dipper and others, investigating the co-speech gestures used by an English speaker with aphasia in comparison to five people without aphasia. The sample taken involved describing a Sylvester and Tweety Pie cartoon. To know more about what they found out click here for free access!

                                                

                                    

It amazes me how gestures can be so powerful in terms of communication that there are languages based solely on them, such as the British and American Sign Language. The British Sign Language (BSL) is the preferred language of many deaf people in the UK. An estimated number of 125,000 deaf adults and 20,000 children use BSL in the UK. It involves the use of gestures, facial expressions, body movements, and space to communicate. Two weeks ago, while I was having lunch with a friend in Westfield, I saw a deaf little girl with her hearing dad. I was very touched to see how naturally she was using sign language, as she was explaining what she wants in her sandwich using signs to her dad, who then translated it to the waitress.

Can you believe that BSL is so intricate, that it has its own system of complex grammar and phonology, which is defined by orientation, location, hand shape, motion and so on…What is even more fascinating is that although it may appear to be very different than spoken language, the child processes of phonological acquisition of BSL and speech development are similar. A single-case study was conducted on a deaf little girl, Gemma, and she was found to follow similar strategies of simplification to typical speech development. You must read this study in order to appreciate the common patterns of BSL acquisition and speech development, it blew my mind away! It is easily accessible for free here.

Across the course of my studies, I really started to see how having a communication deficit impacts on the quality of one’s life, not only adults but even children. It made me realize how blessed we are for all the typical things we take for granted.  Did you know that residents of youth offender institutions have been shown to have a higher than expected incidence of Language Impairment ? See here for a study which highlights the problem of undiagnosed speech and language problems in young offenders.

Specific Language Impairment (SLI) is a developmental disorder and is identified by atypical patterns of language development without a known cause. Although it’s known to be an early years disorder, evidence shows that it can continue into adulthood. Can you imagine the types of difficulties children and adults with SLI can face? Bullying, failure to express needs and emotions, and low self-esteem to name a few.

The effect of specific language impairment on one’s life down the line has not been investigated enough, therefore, Professor Gina Conti-Ramsden and Dr Nicola Botting compared the emotional health of adolescents with and without a history of SLI. They found a higher rate of anxiety and depression in adolescents with SLI, however, no direct link with language impairment was evident. To learn more about how they assessed this and the clinical implications of it, click here for the open access paper.

Anyway as you can see I’ve obviously had far too much free time on my hands this month, lots of interesting reading still to be done! Hope you guys enjoyed my first blog! 

See you next month!