Communication - Comments vs questions in child language development Literacy intervention Speech-language therapy in Fiji - New ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
SUMMER/RAUMATI 2020
ISSUE /NGĀ TAKE 37
communication
Comments vs questions in child language development
Literacy intervention • Speech-language therapy in Fiji
Contents
Rārangi upoko kōrero
1 2 3 4 5 6
From the From the New NZSTA Mutual Ka kite anō au i Te reo o te
editor president board member Recognition a koutou Kaumātua
Agreement:
Who to follow What you
need to know
7 8 9 10 11 12
Questions A case study Getting Pragmatic Interprofess- Obstructive
about using Forbrain started in snapshots ional student sleep apnoea
questions literacy dysphagia
intervention workshop
13 14 16 17 18 20
A world of Gillian Bell Still my Mum TalkLink Trust Members’ NZSTA student
assumptions in Fiji queries and representative
comments experience
Cover: TalkLink Trust supporting staff at the Frank Hilton Organisation Area updates
in Fiji to become proficient in using alternative communication methods.
Submission deadline for autumn edition of Communication Matters: 12 March 2020. Send to editor@speechtherapy.org.nz
ISSN 2324-2302 (Print)
ISSN 2324-2310 (Online)
The NZSTA reserves the right to refuse for inclusion in Communication Matters, any articles, features or advertisements which are contrary to the NZSTA Code of Ethics.
Unless formally stated to the contrary, acceptance and publication of material and advertising does not imply endorsement of views, positions, programmes or products by NZSTA.
Articles may be edited.
From the editor Who to follow
Mā wai e whai?
Nā te ētita
Karen Watson editor@speechtherapy.org.nz
Tēnā koutou, I am pleased to pass the role of
Communication Matters editor to Selena
Happy summer! I hope you’ve had
Donaldson. Many of you will know
a refreshing break and the new
Selena from her work at the University
year has started well. I spent much
of Auckland and Middlemore Hospital.
of my break exploring my own city,
Selena is passionate about good writing
mostly beaches and playgrounds.
and promoting our profession and the
I have a new appreciation for the
NZSTA. I feel confident the magazine
cool Wellington weather and our
will continue to evolve and reflect
always-fresh air, as we learn more and @ DLDandMe
the professionalism of its members
more about the devastating fires in
and board under her guardianship.
Australia, bringing loss of life, habitat,
The international #DLDandme Twitter
homes and quality of life. I hope the Thank you to everyone who has
chat has been fun to follow. Once a
worst will be over by the time this contributed articles during my time
month they do an hour-long chat on
magazine reaches your mailboxes. as editor – I have learnt a lot from the
developmental language disorder
knowledge you have shared, your
This issue will be my last as editor, as (DLD). It’s thought-provoking and
suggested resources and our email
I will soon be taking some time away has connected me with fellow
conversations. I feel like there’s been
from the world of speech-language practitioners in Australia.
an increased interest from members
therapy to have another baby…although
in submitting their work, with a Following #DLDandMe has consistently
parenting surely counts as professional
mix of personal and professional built up my knowledge and confidence
development, right? The first-hand
reflections and research, creating a around DLD. This tweet (above) led to
experience of observing a child’s
better quality magazine. Please keep a fascinating blog post by Laurence B.
development and probably more
up the good work and encourage Leonard highlighting how DLD appears
importantly, a deeper understanding
your colleagues to submit an article in different languages and introduced
of the challenges of family life and
when you see them doing interesting me to the idea of an “exaggerated
anxieties that accompany caring for
work. Thank you to Annette, Amy and linguistic profile”. Specifically, that
children – I certainly learnt a lot the
Shannon for their guidance with the the linguistic errors made by people
first-time round to support my work
magazine. Thank you also to the board with DLD are consistent with what
with families in the education sector.
for the work that you do and always is tricky for all speakers of that
Each child is different, as we all know,
answering my nit-picking questions! language, but that they do it more
so I am looking forward to seeing
often and for many more years. •
what my new baby teaches me. Hei konā mai,
Karen Shannon Hennig
Communication Matters • 1
From the president
Nā te tumuaki
Annette Rotherham president@speechtherapy.org.nz
Mātua Rukingi. Another highlight for programmes will be involved in the
me was the Waiariki Stroke Conference process in 2020 and Massey University
in Rotorua in October. The Honourable in 2021. Keeping everyone busy!
Paula Tesoriero, Disability Rights
This year holds many new paths for us
Commissioner, attended and
all. We bid farewell to some wonderful
participated in the workshops, as well
board members last year, with Amy
as many Māori whānau and individuals
Oughton stepping down in September
who have been affected by stroke.
Tēnā koutou, and Renee Taylor taking a step back
The stories flowed as people shared
this year. Thank you to both of you for
NZSTA had a hugely successful year their experiences. The take-home
bringing such fresh energy and insights
in 2019. Highlights for me have been message was to ensure we address the
to your roles. The portfolios will be up
building relationships. The noho marae wairua of a person in our rehabilitation,
for nomination and voting at the 2020
for the NZSTA Board and conference listen to the whānau and involve them
AGM. In the meantime, our constitution
as much as possible, and consider
planning committee was a fantastic allows me to appoint members to fill these
a wide range of activities that might
opportunity to strengthen our own roles temporarily. It has been fantastic to
address the individual needs of a person.
relationships as a board and to make have Shannon Hennig come on board
Waiata, art, and music were identified as
important connections with Mātua with a baptism by fire over the last three
important tools to living well post-stroke.
Rukingi Haupapa and his whānau. months: thanks, Shannon, for your hard
The successful Brisbane conference Another stand-out event was the mahi at such short notice. We are excited
also strengthened our relationship reaccreditation of the University of to have Katrina McGarr stepping into the
with Speech Pathology Australia and Auckland Speech Science programme: Māori and cultural development portfolio
its members, some of whom will make an important task of the NZSTA. Felicity holder role this year, bringing some South
it over the ditch to our 2020 NZSTA Bright came on board in 2019 as the PAC Island representation to the mix. We look
conference in Christchurch. It will be a (Programme Accreditation Committee) forward to working with Katrina with her
pleasure to show them our manaakitanga. chair, and she has led with integrity and gentle and humble demeanour but always
professionalism. Ngā mihi nui, Felicity. insightful worldview. Our next association
We continue our journey exploring This process was a huge undertaking hui is in Ōtautahi – hope to see you there!
biculturalism: what this means for our for all involved. I also thank the rest
profession and for the people we serve. Enjoy your summer and wishing
of the PAC team and the accreditation
you every success in 2020.
Our new NZSTA waiata encompasses panel who ensured this process met
this mahi for our profession and for the standards and was carried out Hei konā mai i roto i ngā mihi,
our people: an amazing gift – ngā mihi, smoothly. The University of Canterbury Annette
2 • Communication Matters
New NZSTA board member
Shannon Hennig, Communications / Tūranga whakapaoho portfolio holder
communications@speechtherapy.org.nz
Kia ora koutou, I am stepping in for the remainder of Collectively, as we share stories
Amy’s term and am looking forward to and celebrate our achievements,
Firstly, a huge thank you working with all of you to ensure that we can make a significant
more people understand and value impact towards these goals.
Amy Oughton for all she did the work we do in our profession.
One of the stories that touched me
for the communications /
My dream is that everyone with last year, was the coming together
tūranga whakapaoho swallowing or communication difficulties of so many people to create the
portfolio. The Giving Voice can access our essential services. As Awhi Mai Stroke Trust conference at
part of that, I hope that one day every Te Papaiouru Marae in Ōhinemutu.
Aotearoa infographics, video young person in New Zealand will know I wish I could have been there, but if
competition, and social enough about our profession to consider you also weren’t able to be there in
media presence were greatly it as a possible career path. Can you person, I’ve put together a video about
imagine if every young adult knew about the event. This video also features one
appreciated. Thank you for what we do at the same level as they of the waiata written by our Kaumātua
your service to the association could describe what a plumber, doctor, Rukingi Haupapa. Head over to our
teacher, scuba diver, or astronaut does? YouTube channel, where you’ll find this
and all the best with your video along with a collection of waiata
I also plan to work hard to promote
future projects. communication accessibility in this
written for our association by Rukingi.
role. I truly believe that if we could help Until the next edition, go well everyone,
the entire population understand how and follow along on Facebook and Twitter.
simple changes can profoundly impact
Auguri a tutti! •
someone else’s ability to connect and
communicate, the world would be very
different for so many New Zealanders.
New Zealand Speech-language
I believe that stories are what change
Therapists’ Association
the world. Stories from people we
know and trust. Stories that are honest, @NZSTAcomms
poignant, nuanced, and reflect the (our new Twitter handle).
diversity of our world.
Communication Matters • 3
Thinking of working overseas:
What do you need to know?
Anna Miles, Professional standards/Tūranga ūmanga portfolio holder, professionalstandards@speechtherapy.org.nz
For many of us, one of the led to the speech-language therapy
profession advocating for people Requirements for
incentives of a career in with communication difficulties acceptance into an MRA
speech-language therapy is at the United Nations last year. association through MRA
the ability to work abroad. The MRA is based on “substantial 1. Full member of the NZSTA.
equivalence” between the
Mutual Recognition 2. Completed 1 year of supervised
associations. Much of the NZSTA’s
Agreement (MRA) practice – completed New
self-regulatory processes are based
Graduate Framework.
The NZSTA has worked hard to build on the establishment of a transparent,
the respect of other associations robust, professionally and ethically 3. Recency of practice – at least
worldwide to ensure our members sound basis of mutual recognition 1000 hours in the last 5 years
are recognised. The NZSTA was of credentials of speech-language
4. Dysphagia education /
accepted by the MRA in 2008. The therapists across the signatory
competency – trained in NZ
MRA is an agreement between the associations. This includes the code
after 1992 or other evidence
American Speech-Language-Hearing of ethics, scope of practice, academic
of dysphagia competency.
Association (ASHA), Speech-Language preparation, programme accreditation
& Audiology Canada (SAC), Irish and certification standards such as 5. A letter of good standing
Association of Speech and Language continuing professional development, from the NZSTA. See the
Therapists (IASLT), New Zealand Speech- new graduate and return to practice NZSTA website for details
language Therapists’ Association standards. For the NZSTA, this means of requirements.
(NZSTA), Royal College of Speech these standards need to be met in
and Language Therapists (RCSLT) and order to continue to meet our MRA. It is important to note that ASHA
Speech Pathology Australia (SPA). requires a master’s level degree
For NZSTA members, this means in addition to these requirements,
The MRA ensures respect, protection that we can gain membership in and both ASHA and SAC
and international understanding these countries at a lower cost and require you to sit an exam.
between associations, facilitates with fewer requirements of evidence.
mobility and responds to trade barriers, What this does not mean is automatic
as well as promotes and advocates entry into these countries and the
for the profession at an international workforce. Members are urged to and to check the immigration, national
level. The International Communication check the specific requirements for and/or state licensing requirements
Project came out of the MRA and this membership for these associations of the place you wish to travel to.
4 • Communication Matters
Qualification approval
All is not lost, if you do not meet the
requirements to be accepted by an
Ka kite anō au i a koutou
association through MRA. All the MRA Renee Taylor, Māori & cultural development / Tūranga kaupapa Māori,
associations have a second qualification culturaldevelopment@speechtherapy.org.nz
approval route for other countries that are
not in the MRA. If you wish to become We hope to hit the ground running
a member of another MRA association with strategic planning and
without meeting the MRA requirements prioritising of goals for 2020. In my
(e.g. straight after qualifying), you need to two-and-a-bit years of leading this
apply through the qualification approval portfolio, I have learned a lot. It’s
route. This is likely to involve more not all been smooth sailing – a role
paperwork so as a student it is critical that like this never is – however there
you investigate the evidence you will need Kia ora koutou, have been some monumental
to supply early so you collect this during shifts in the direction of our
your studies. Typical evidence includes It is with a heavy heart that I let you
association. I do believe we are
direct clinical contact hours and course all know I have decided to step
heading in the right direction. It
outlines with a breakdown of academic down from my role on the NZSTA
may be a long journey but if last
and clinical hours in each subject. Board. I’ve had to make a few big
year was anything to go off then
decisions in my life and decided to
I’m excited to see what’s to come.
The future of the MRA focus on some other areas for now.
Recently I represented the NZSTA in I hope you all have a safe and
I won’t be leaving you high and
Orlando at an MRA Advisory Group memorable summer. Take care of
dry though! The wonderful Katrina
three-day meeting. We were repeating yourselves and your loved ones.
McGarr has agreed to take on
the crosswalk of the six MRA signatory Check on your lonely neighbours
the portfolio. I will also still play a
associations to ensure substantial and remember to stay hydrated.
supporting role. So, technically
equivalency still held true. We were also now we’re just an awesome trio: Ngā manaakitanga,
preparing guidelines for new international Katrina, Mātua Rukingi, and me! Renee
applications to the MRA Advisory
Group after several recent inquiries.
Currently, SAC is the only MRA
association accrediting a speech-
language therapy programme in a Whenever you find yourself doubting how far
language other than English. SAC have
six training programmes conducted in you can go, just remember how far you have
French. The MRA signatories strive for – (author
unknown)
come. Remember everything you have faced,
inclusion, not exclusion, and are working
on how to ensure the future of the MRA all the battles you have won and all the fears
includes diversity and truly represents
speech-language therapy worldwide. •
you have overcome.”
Communication Matters • 5
Te reo o te Kaumātua
Rukingi Haupapa
Kia ora mai tatou, This activity gave all a chance to get were some serious gaps in energy and
up close and personal, and at the very skill. Thankfully the speech-language
Giving Voice Aotearoa least have an idea of the similarities and therapists stepped forward. A huge
differences between each organisation. thank you to Annette Rotherham, Renee
Awareness Week in This was also the first time for Māori Taylor, Felicity Bright, Phillipa Friary,
September 2019 was full of Bay of Plenty consumers to be able to Fiona Dominick, Jo Hall, Katrina McGarr,
awesome activities across ask questions to the teams supporting Liz Cross and Meghann Grawburg
them. All in all, this was an excellent who juggled their worlds to volunteer;
the Bay of Plenty. In Maketu, exercise which will no doubt be from washing dishes to managing the
Whakatane, Rotorua and repeated in 2020. Ngā mihi nunui ki a registration role to caring for stroke
koutou katoa i awhi mai, i tautoko mai. survivors. A thank you to Felicity, Phillipa
Tauranga, speech-language
In October, the first Māori Stroke and Fiona who also organised some of
therapists, Aphasia NZ, and their past and present university students
Conference was held in Ohinemutu,
Stroke NZ staff presented Rotorua. Survivors and whānau across to volunteer – Cassandra Hum, Catherine
to Māori stroke survivors the Bay of Plenty were the focus group, Forrest, Claire Fouhy, Shauna Pali, and
however we also had whānau from Tainui Wei Kai Syu. The crew from Monday to
and whānau, and Māori and Te Tai Rāwhiti. It was exactly as we Thursday were dedicated to ensuring
community members such as thought it would be – absolutely, mind- that this conference was successful and
blowing! A major issue that most whānau ran without hiccups! Wei, our paparazzi
kaumātua groups, about who star, took many photos to record this
had expressed in research (Richards,
they are and what they do. 2015; Haupapa, 2019) was that most had historical moment, so a special thank
little or no chance to meet and talk with you to him. Arohanui ki a koe e Wei,
other whānau who had been through ki a koutou katoa ōkū hoamahi.
the same journey. The sharing during I wish you all the best over the
the conference involved a lot of tears,
holiday season and look forward
laughs, and hugs. Once emotions were
to meeting again in 2020.
released, all began looking to the future
which is now looking bright and shiny. Ngā whakawhētai o te Wāhi Ngaro
ki koutou katoa huri noa i te motu.
The conference organisers were Māori
stroke survivors which meant there Nāku noa,
was a lot of passion and will, but there Rukingi
6 • Communication Matters
Questions about questions
Dr Jayne Newbury, lecturer in paediatric speech and language disorders in
the School of Psychology, Speech and Hearing, University of Canterbury and
NZSTA expert advisor on child language, jayne.newbury@canterbury.ac.nz
Kia ora koutou katoa, Rowe, Leech and Cabera (2017) reported Based on this evidence, consider whether
that fathers’ wh- questions directed to focusing on coaching responsivity (rather
Don’t ask questions – make more
2-year olds positively correlated with than discouraging adults from asking
comments! This is advice we frequently
vocabulary and reasoning outcomes questions) might have a better effect?
give parents and teachers. However,
one year later. Children’s responses to
are questions unequivocally bad for If you’d like talk about this, feel free to
wh- questions were more syntactically
children’s language development? email me.
complex and frequent than their
We know that responsivity is a positive responses to other types of questions. Ngā mihi nui,
predictor of language development – The authors suggested the challenging Jayne
that is, when an adult responds in nature of wh- questions stimulated
an immediate warm positive way to vocabulary and reasoning development.
the child’s state of being or interest References:
Questions can be not responsive Camarata, S. & Yoder, P. (2002). Language
(Tamis-LeMonda & Bornstein, 2002).
e.g. the child is playing with the train transactions during development and intervention:
We also know that rich linguistic input
and the adult says, “what colour is theoretical implications for developmental
is important for a child’s language neuroscience. International Journal of
the pig?” Non-responsive questions
development (Sandbank & Yoder, 2016). Developmental Neuroscience, 20, 459-465.
can be fired at a child to test their
Are questions inherently not responsive Levickis, P., Reilly, S., Girolametto, G., Ukoumunne,
knowledge and inadvertently put
and linguistically impoverished? O. & Wake, M. (2018). Associations between
pressure on the child, reducing the maternal responsive linguistic input and child
Conversational questions can in fact likelihood the child will be confident to language performance at age 4 in a community
be both responsive and linguistically speak. However, responsive questions sample of slow-to-talk toddlers. Child: Care, Health
informative for the child. For example, continue a conversation on the child’s and Development, 44, 776-783.
interest. They promote the back and Rowe, M., Leech, K. & Cabera, N. (2016). Going
Child: Cat! beyond input quantity: Wh questions matter for
forth communication which is needed
toddlers language and cognitive development.
Adult: Is the cat going to climb the tree? for development of conversational skills Cognitive Science, 41, 162-179.
(Camarata & Yoder, 2002). Responsive Sandbank, M. & Yoder, P. (2016). The association
Child: Cat up tree!
questions can be linguistically rich between parental mean length of utterance and
Responsive questions (such as the and model new and complex syntax language outcomes in children with disabilities:
example above) are positively associated constructions for the child. They can a correlational meta-analysis. American Journal of
with a child’s language growth between Speech Language Pathology, 25, 240-251.
expand semantically on the child’s
Tamis-LeMonda, C. & Bornstein, M. (2002).
ages 2 and 4 years (Levickis, Reilly, interest, and signal to the child that it is Maternal responsiveness and early language
Girolametto, Ukoumunne & Wake, 2017). their turn to talk now, and that the adult acquisition. Advances in Child Development and
is interested in what they have to say. Behaviour, 29, 89-127.
Communication Matters • 7
A case study using Forbrain
Grace Lindley, speech-language therapist working in France
Forbrain is a wireless headset that uses Josie’s progress was quick and Week 5
a microphone and bone conduction to remarkable. Here are some of her New targets added: /ʃ/, /θ/ and /ð/.
give you automatic and slightly enhanced therapy milestones:
feedback about how your speech Week 6
sounds. I employed it recently with a Week 1
Josie was stabilising all sounds in
child, Josephine, and found it helpful Josie appeared shocked when she heard conversational speech; with still the odd
with enhancing her self-awareness. herself use /l/ instead of /s/, began confusion between /f/, /s/, /ʃ/ and /θ/.
to spontaneously self-correct. Repeated Josie was discharged as her speech was
I met Josephine in June 2018 when /s/ to herself in the microphone over
she was 4 years old. She presented now completely intelligible to unfamiliar
and over. listeners. Strangers now understand
with unusual phonological processes
across most of her sounds, making her Josephine when she introduces herself!
Week 2
unintelligible to unfamiliar listeners. It Again, she appeared surprised to hear Josie was seen six months later; all
was incredibly frustrating for her because herself use /w/ instead of /f/. Again, her targets had generalised into
she was a huge chatterbox! What was repeated the sound to herself over and conversational speech and she sounded
particularly heartbreaking was that no over. Josie had begun to use final /s/ in just like a typically developing child.
one understood her when she said her conversational speech.
own name, which she pronounced Clinically, I felt the Forbrain accelerated
“do-eh ween.” Furthermore, Josie had her self-awareness of sound production.
Week 3
very poor awareness of her own speech. From a service perspective this hastened
Josie commented on how she used to her discharge from therapy. Josie loved
She was adamant that she was saying say things versus how she says them
things correctly and if her mum tried to wearing the Forbrain and listening
now. For example, “Grace, I used to to herself make different sounds, it
correct her she would yell “Bat what I led” say lubway lanwiches but now I can
(that’s what I said), or “I didn’t lay lock I motivated her to stay on task and gave
say subway sandwiches”. She was her crucial feedback about when she
laid lock” (I didn’t say lock I said socks). consistently using medial and final was using her sounds correctly. •
We used a cycles approach with minimal /s/ in conversational speech.
pairs, for two 30-minute sessions per Note: I rent office space from the
week targeting the sounds that most Week 4
company that markets Forbrain in France.
impacted her intelligibility first. Josie was now using all targets I receive no financial benefit for sharing
in conversational speech. Some this article.
confusion between /f/, /s/ and /θ/.
Right:
8 • Communication Matters Forbrain wireless headsetGetting started in CATCH
literacy intervention THE
LITERACY
Voon Pang, Skill Builders Speech Language Therapy
BUG
I was first introduced to the idea of processing skills and poor phonemic Upcoming continuing professional
speech-language therapists working awareness skills. Some reading difficulties development events
on literacy more than 10 years ago as can be explained by biological factors such
I was completing my degree at Curtin as poor phonological memory or a familial
University. I remember thinking as a history of dyslexia. Others simply have not
new graduate that reading instruction received the adequate amount of explicit The Lift to Literacy:
and spelling intervention was something instruction or have enough opportunities Bridging Science to Practice
left to the teachers and remedial tutors. to practice blending or segmenting 16 – 27 March 2020: 1-day
I swore I would never work with kids sounds and graphemes when learning to events in Dunedin, Christchurch,
who couldn’t read or spell! I never read and spell. Who are the students who Palmerston North, Invercargill,
imagined that in 2019 I would advocate struggle the most or have the highest risk Hamilton, Auckland.
for our involvement with students for reading or spelling failure? Unfortunately,
who struggle to read and write. it’s the kids we see with speech and Presenter: Dr Pam Kastner
language impairment who often get left Find out more: www.facebook.com/
I started working with school-aged
behind once they enter school, and do not jandjliteracy/ or contact Janice
students with reading and spelling
receive high-quality reading and spelling Belgrave on jandjliteracy@gmail.com
difficulties after attending a Speech
instruction needed to help them make
Pathology Australia (SPA) workshop on
sense of the “squiggles” in front of them.
literacy intervention in 2017. Prior to this,
I had noticed conversations and posts “There is a role for [speech-language Learn How Words Work:
by speech-language therapists on social therapists] to work directly with school- Spelling Development,
media were changing and it became age clients who have literacy-related Assessment and Intervention
clear that my Australian counterparts problems, complementing what they 15 June 2020: 1-day
were becoming more involved in the receive at school. It goes beyond working event in Auckland.
world of reading and spelling instruction. on phonemic awareness; individual or
Experienced clinicians and researchers small-group therapy can usefully target Presenter: Jenny Baker
also started to offer workshops in the remnants of the phonological difficulty Find out more: bit.ly/2tjRMLy or
Australia so off I went to catch the in children’s oral language and develop www.skillbuildersslt.com/training
“literacy bug”! I became Sounds-Write strategies for sharpening their phonological
trained and attended other various representations, while respecting their
workshops to improve my confidence phonological working memory problems. Consider joining the NZ Language
in working in this area. This kind of targeted support for reading and Literacy Facebook Group
and spelling is very difficult for a teacher overseen by Emma Nahna of Talk
I now see students from years 1 to 6,
to offer in the whole-class setting” – Tree Speech & Language Therapy
most of whom have weak phonological
Dr Ros Neilson (Bowen, 2015, p. 163). •Pragmatic snapshots
Wendy Rinaldi, PhD, speech-language therapist, England, wendy@wendyrinaldi.com
I can’t believe it’s now thirteen years impact of communication skills. There is when they are reprimanded. Instances
since I spoke at the NZSTA conference growing evidence for the effectiveness like this highlight the importance of
in Christchurch – it was a wonderful of these kinds of approaches. screening for difficulties with inference,
opportunity. Since this time, alongside educating staff and developing
Developmental studies suggest different
my work as a therapist, I have focused suitable therapy programmes.
kinds of inferencing skills develop at
my research on pragmatics and am
different stages. Children can pick When helping students infer meaning,
currently conducting a standardisation
up on contradiction between what one of the challenges of developing
of the test Identifying Difficulties with
someone says and the situation from therapy programmes is the “translation”
Inference that emanated from my PhD.
as young as six, but some aspects of of abstract into concrete. For example,
I have kept in touch with New Zealand
inference do not develop until later. I use pictures of cartoon characters using
and Australian colleagues and am aware
For example, being able to rule out strategies to work out meanings from
that many of the needs and challenges
meanings of words or phrases that context – thinking bubbles are key!
faced by youngsters in the United
are implausible in context when the
Kingdom are shared across the oceans. Please email me any questions
meaning that is plausible isn’t known.
or comments. •
In this article I have included some
Difficulties with inference can be
pragmatic “snapshots,” looking at
mistakenly interpreted as manipulative Wendy has written a longer version
two aspects of pragmatics: social
behaviour. For example, rhetorical of this article with references, please
interaction and inference. In the area
questions can be used as a warning contact editor@speechtherapy.org.nz
of social interaction I find it’s the focus
to manage behaviour. Children who if you would like a copy.
on social understanding that’s effective
can infer are able to pick up on the
because this enables meaningful use
formality of a situation and the angry
– the student gains an understanding
voice or facial expression of a figure
of how communication skills such as
of authority to realise that an answer
eye contact, listener feedback and
is not required. However, if a child
conversational skills can be helpful to
cannot pick up on these cues, they
them to manage even the trickiest of
may answer the question, thinking they
situations. Youngsters I have worked with
are being genuinely helpful. Other
who started out with low self-esteem,
children may laugh at this behaviour
sensing that they were somehow at fault
and it can be seen, mistakenly, as being
but not understanding why, were able
manipulative or attention-seeking. The
to develop a much better outlook when
child who was unable to infer can then
they could understand more about the
be understandably confused and upset
10 • Communication MattersCase based modified texture lab:
Interprofessional student dysphagia
workshop at Massey University
Emily Jones, senior professional clinician, & Annabel Grant, clinical
educator, Massey University Bachelor of Speech and Language Therapy
(Hons) programme
Last year our Year 3 and 4 students from Getting past the look of the food caregivers and having reduced oral intake
the speech-language therapy honours The workshop provided the due to fatigue. The dietetic students talked
programme participated in a modified opportunity for our students to about how to use fortifiers in the foods to
food lab with the Master of Nutrition and experience modified foods first-hand. boost calories, e.g. using chicken broth
Dietetics students. The goals for the lab Our students commented on the fact and milk, especially for the pureed, Level 4
were for the students to communicate that on recent placements some of foods. They also discussed difficulty of
and work together when planning meals their patients would gag at the sight foods continuing to thicken on standing
for patients requiring a modified diet. of modified food in the hospital setting. which then changes the desired texture.
This was achieved through applying We felt that it was important for them
patient-centred practice to problem to try the altered textures they will Future partnerships
solve some typical case studies. recommend for their future clients. At Massey University, the speech-
language therapy and dietetic students
The dietetic students created a variety The dietetic students used moulds and
Flavour Creations Shape It ® to present work together for their on-campus
of different meals in the following
fish and vegetables. They also made and community clinical placements.
International Dysphagia Diet
sandwiches in all three categories, In their interprofessional pairs, they
Standardisation Initiative (IDDSI)
which were impressive. The dietetic assess, plan and provide intervention
categories:
students talked us through the process for patients throughout the lifespan.
• Level 7 – Normal diet of how they made the Level 4 sandwich We know that by working together
• Level 5 – Minced and moist appear as closely as possible to Level 7. while training these relationships, the
Using the moulds generated lots of teamwork and communication will
• Level 4 – Puree
discussion on the practicality of large continue into their professional lives
In preparation, the speech-language hospitals using them with the number (Attrill et al., 2018; Morphet et al. 2014;
therapy students met to discuss three of people they need to cater for. Thistlethwaite & Moran, 2010). •
case studies of adults who required
modified diets. They presented these Problem solving Thanks to Garalynne Stiles from
cases to the dietetic students and as The students discussed and problem the Master of Nutrition & Dietetics
a team they discussed the suitability solved issues such as patients’ delayed Programme and Margaret Alexander
of the prepared foods for each case. rate of feeding, being dependent on from Flavour Creations ®.
Communication Matters • 11Obstructive sleep apnoea:
A role for speech-language therapists?
Emma Wallace, PhD, speech-language therapist and post-doctoral research associate
at Adelaide Institute for Sleep Health, Flinders University.
What is obstructive sleep apnoea? How is it treated? Perhaps one of the most important, yet
Obstructive sleep apnoea (OSA) is The most common treatment for OSA under-recognised roles for speech-
a sleep disorder, characterised by is continuous positive airway pressure language therapy is with patients with
repeated narrowing, or closure of (CPAP). CPAP works by blowing a OSA who opt for surgery. Adverse
the upper airway. The reasons why continuous stream of positive pressure speech and swallowing outcomes are
the upper airway closes are poorly into the airway via a mask to splint reported following surgeries, which often
understood. Recent models suggest that it open. Although this treatment is involve removing parts of the uvula, soft
in addition to a narrow or “collapsible” highly efficacious at reducing airway palate and base of tongue. Prophylactic
upper airway, patients with OSA have narrowing and closure, it does not exercises used for patients with head
different pathophysiological phenotypes target the underlying pathophysiology. and neck cancer to preserve swallowing
including poor upper airway muscle Other treatments include upper airway and speech functions may be beneficial
responsiveness, low arousal thresholds, surgery, mandibular advancement
to patients with OSA. As well as pre-op
i.e. they wake up too easily and/or high splints, upper airway muscle training
counselling regarding potential adverse
loop gain, i.e. their breathing is unstable and pharmacological treatments.
effects on their speech and swallowing.
in response to respiratory perturbance.
What is the role for speech-
How is it diagnosed? language therapists? Conclusions
Diagnosis of OSA is based on a sleep The upper airway is a shared anatomical There is an exciting opportunity for
study where brain waves are recorded region for breathing, swallowing and speech-language therapists in the
via ECG electrodes. Oxygen levels, speech. OSA is an impairment of the management of patients with OSA.
heart rate, breathing as well as leg and upper airway and many of the treatments Further research is needed to explore
eye movements are also recorded. The involve modifying upper airway the effects of pre-morbid OSA on speech
presence, absence and severity of physiology. Thus, its unsurprising that and swallowing outcomes following
OSA is determined by how many times speech-language therapists could play stroke and the potential of prophylactic
the airway closes (apnoea) or narrows an important role in the management. exercises to prevent adverse speech and
(hypopnea) per hour. Activity of the Furthermore, patients with OSA are swallowing outcomes following surgery. •
upper airway muscles (specifically the at high risk of cardiovascular diseases
genioglossus) can be measured using and are often seen by speech-language
Please contact
small fine wire EMG electrodes that are therapists on the stroke ward. Whether
editor@speechtherapy.org.nz
inserted into the tongue. Pressure in these patients are at higher risk of
for the reference list.
the upper airway is recorded via small speech and swallowing impairment
catheters that are positioned at the post-stroke due to their pre-morbid
base of the tongue and soft palate. OSA is not known, but highly likely.
12 • Communication MattersA world of assumptions
Eric Knapp, member of the NZSTA consumer group
I can walk, drive and talk and eat regular pub – without my cane – to my car.
foods, however not at 100 percent. Some people stopped me getting into
I wobble, I can only drive an automatic my car as they thought I was trashed.
car (which is fine by me), I slur and talk Their intentions were good, and they
slowly, I sometimes choke on my food were so apologetic once I told them
if I’m not concentrating. All of which about my stroke. I even told them the
was achieved via intensive rehabilitation previous story to make them feel better.
with physiotherapists and speech- The phone is no better. I once ordered
I feel my world seems to be language therapists from The Rose fish and chips over the phone. My partner
Centre, where I now work part-time.
built on assumptions…which at the time picked them up and the shop
I don’t really need a cane to aid me; assistant “joked” was I too drunk to pick
turn into judgements. It’s I use it as a visual aid, so people realise them up? This really made her angry,
contagious as I find myself that I’m not drunk. (The other reason as you can imagine. So, I have anxiety
doing the same thing! is to play with the cat.) I once walked answering calls from unknown numbers
into a club without my cane and was and making calls to places like insurance
I’m a 39-year-old male living with a immediately stopped by the bouncer companies or mechanics. I need to
disability from a stroke which I had saying I was too drunk to enter. He constantly repeat myself or disclose that
six years ago. Before I had my stroke, apologised after I said I had a stroke my speech is slurred due to a stroke.
I was “uneducated” about people and let me wobble on in. Just so you
with disabilities. I was unaware So, as I mentioned before: assumptions.
know, I don’t drink that much as it affects Our society is full of them. We can’t
of their difficulties in the world my balance and speech a lot. As I was
today. I took things for granted. be rid of all assumptions overnight,
walking out I noticed the same bouncer but we can put measures in place
Now with disability I feel my life was having the same conversation with so our disabled brothers and sisters
has changed for the better. I’m just a guy who was completely off his face, can live in an easier world. •
playing the “game of life” at a harder so I thought I’d be a bit cheeky and
mode. Having a disability is hard; yelled, “I said I had a stroke and he let
some disabilities are harder than me in!”. The bouncer wasn’t impressed.
others. Society makes it difficult.
Another time I was going home after
I was a full-time fire fighter driving having a few (non-alcoholic) drinks
heavy vehicles for 12 years. Then the with my firefighting brothers. It was
stroke happened. My career ended. still daylight as I walked out of the
Communication Matters • 13Gillian Bell: Speech-language
therapist 1973–2019
Gillian Bell
This feels a bit like writing I arrived here from Yorkshire in July I applied and started a week later. I
1973 aged 21: fresh out of training saw inpatients and outpatients. I was
my own obituary so I hope in Leeds, with my new Kiwi husband part of the cleft palate team which
it doesn’t sound like I’m whom I’d met on a Greek island a held a monthly clinic for children
few years earlier. The course I had with their parents where they were
blowing my own trumpet
done (which was the only available assessed by a room full of specialists.
(but this perhaps could be speech-language therapy training in I always felt rather sorry for them as
useful when I do pop my those days) was a three-year Diploma they were poked and prodded, then
in Speech Pathology and Therapeutics. I had to ask them to say a few words
clogs – not for a while I hope!) When I arrived in Wellington, the before it was decided if they needed
I want to share a little of my only vacancy was in Masterton with a pharyngoplasty, or orthodontics
experience as a speech- the Education Department. I had no and so on. I don’t remember any
car, and it would have been difficult discussions about feeding!
language therapist working to commute from Johnsonville to
My clinic was what used to be the linen
in New Zealand for quite a the Wairarapa, so I didn’t apply.
cupboard, so it was very small. It was
long time: 46 years in the I wanted a hospital job so asked around part of the day centre, mainly for stroke
and discovered Joan Gordon, the patients and some other neurological
profession. I have seen a lot district speech-language therapist conditions. I loved being part of a
of changes for me personally for the Education Department, was multidisciplinary team and they were
and for speech-language also the consultant speech-language very welcoming. I also saw several
therapist for Wellington and Hutt laryngectomies and we started the Lost
therapy in New Zealand. Hospitals. She visited once or twice a Chord Club, named by the members.
week, assessed the patients she was
In 1989, I took a sabbatical to do a
referred, then saw them privately!
Master of Science in Disorders of Human
I cheekily rang Hutt Hospital and asked Communication at City University in
if they would like a speech-language London. This course was run by Margaret
therapist based there as I’d heard the and Bob Fawcus and we were lucky
plastic and ENT (ear, nose and throat) enough to have James Law, David
surgeons were keen to have someone Howard, Jane Marshall involved with
on the spot. The job was advertised, aphasia groups as our tutors. We did
14 • Communication MattersComparing the speech-language therapy services provided
in New Zealand with other parts of the world shows how well
– Gillian Bell
we stack up (although access and funding of resources are
often not as great here). ”
clinical visits to local hospitals, such as Disabled Unit. I left there in 1996 due Over the years I have observed the
Middlesex with their specialist voice to health concerns and decided to go increasing emphasis on treating
therapists working with transgender into private practice part-time. I also dysphagia in hospital patients,
patients. I also went to Frenchay worked as a field officer for the Stroke different approaches in the Ministry of
Hospital in Bristol which is famous for Foundation, that myself and Kay Miller Education, the mushrooming of private
AAC (augmentative and alternative had started in 1979 with a six-month practitioners and speech-language
communication) and computer-based pilot scheme using trained volunteers therapists working outside the original
aphasia therapy. I wanted to stay another helping people with aphasia. boundaries. Comparing the speech-
year for an advanced aphasia course language therapy services provided
In 2005, I moved up the coast to Levin
(my pet subject), but my husband and in New Zealand with other parts of
and started work with the Explore
daughters were itching to get back to the world shows how well we stack
Team of NZCare Disability. We assisted
New Zealand, so it didn’t happen. up (although access and funding of
the former residents of Kimberly
resources are often not as great here).
When I had school-aged children, Psychopaedic Hospital to settle into
I worked part-time at Kenepuru Hospital community living. Many of these people Recently, I have reduced the number
in Porirua. At this point I started another had been institutionalised for most of of clients in my caseload. Becoming
group, also named by its members: their lives and had major communication somewhat deaf and realistically not
SCOPE (Social Communication and swallowing problems. Much of our making much of a profit has helped me
Overcomes Public Embarrassment). work was training staff in the group decide to end this chapter of my life.
I also ran these groups in Wellington houses as well as assessing and advising
So, to conclude this lengthy story I
and Kāpiti from 1986 to 2016. on the residents’ longstanding disabilities.
think speech-language therapy in
When my husband’s job was transferred In 2010, I decided to take the plunge New Zealand is in a very healthy position
to Dunedin, I worked at Dunedin and work privately full-time, as I was and after many years we are finally
Hospital with Julia Brett (I’d love to getting an increasing number of recognised as registered professionals.
re-connect, if you’re reading, Julia!). ACC referrals. I was also doing more I wish everyone in this challenging and
When my Dad died, I flew back and locum work at ABI in Wellington, rewarding career the very best. I hope
forth from the United Kingdom and Wanganui and Wairarapa Hospitals. to offer some clinical supervision locally,
Julia was a very understanding boss. if that can be arranged. Once a speech-
From time to time I have enjoyed
language therapist always a speech-
We moved back to Wellington in using music and dogs in therapy
language therapist, even in retirement! •
1993 and I worked again at Kenepuru (not necessarily together!)
Hospital, this time in the Young Physically
Communication Matters • 15Still my Mum
Tracy Kendall
I recall vividly when the neurologist, who in place of real speech and is unable to
just happened to be my own brother, follow simple, one-part commands.
sat me down to explain that our mother,
My Mum will not walk again after a
who had been most forgetful of late, had
broken hip, is incontinent, unable to
Alzheimer’s, and would eventually not
communicate effectively, is fed soft foods
recognise even her own family members.
and has no free will. But, is she still her?
A cold chill of fear crept through me
I glance around her hospital room at
and I wondered when that day would
the beautiful embroidered pictures she
be. Twelve years into this tumultuous
stitched, at the photos of her interacting
journey, we’ve reached that place.
joyfully with her grandchildren, and the
My parents were a match made in picture of her as a star bridge champion.
heaven, they shared everything – even Is she still her? Without expressive
the same illness. While my father was language or understanding, is she still
ambitiously supporting my mother the person that was my Mum? The
with her Alzheimer’s, we realised that essence of her is still Mum: the tilt of
he too had dementia, of a devastating, her head, the unexpected laugh at
more dramatic and hastier type than something funny, a loving expression for
there are still the colourful threads of
my mother’s. My father passed away me while we sit in comfortable silence,
love that bind and stitch us together.
three years ago, leaving my mother looking at the gardens. My Mum is still
alone in the locked dementia unit of my Mum, and I am still her daughter. I have recently become a grandmother
the rest home. A few months later, my I remember who she is, and at the end of for the first time. My Mum is a first-time
Mum, then aged 84 years, forgot who the day, I think that’s what really counts. great grandmother. Three generations
her husband was and that she had of women will together love a new little
Alzheimer’s is a journey of love, done
been married for over 60 happy years. baby girl. The frail great grandmother
backwards. I liken this journey to
greets the helpless newborn with loving
In my private speech language therapy peeling an onion ever so slowly. Each
arms: that does not need words.
clinic, I encourage and help whānau layer peeled off the onion reveals new
and their tamariki develop speech and challenges, with tears along the way, Alzheimer’s is a mindless, maddening
language. Yet behind the scenes, until you reach the sweet, soft kernel in illness, but it teaches us most ironically
I observed my Mum’s expressive and the middle, that is love. When you have to be mindful. To seize the sweet
receptive language slip gradually loved and been loved, words don’t little moments in time as they occur,
backwards through the phases I am matter anymore: hers or mine. When then bask inside them and celebrate
moving children’s language forward in. everything else is stripped away and the goodness that is called life. •
My Mum now uses expressive jargon communication has long since fled,
16 • Communication MattersTalkLink Trust support in Fiji
Jessamy Bell, speech-language therapist, TalkLink Trust
At the end of 2017, Shelley Kennedy, Occupational Therapist Amanda
an occupational therapist working at Roberton and I visited Fiji for five
Frank Hilton Organisation in Suva, asked days in February 2019. We assessed
TalkLink Trust whether we could provide 13 people (students, young adults
support, resources or advice for the and teachers) and ran seven training
students she was working with. This led sessions covering what makes a good
to several Skype sessions, emails and communication partner, using core
in-person meetings with Shelley when boards, visual timetables, alternative
she visited Auckland, and a plan for pencils for writing and more.
core boards for their classrooms and
two therapists to visit Fiji was arranged.
I would like to share a highlight from the for individual students. They reported
Funding came through towards the
training that Amanda and I provided to that watching videos of real students
end of 2018 and the trip was booked.
some of the speech therapy assistants, in New Zealand using core boards
Frank Hilton Organisation operates teachers, teacher aides and outpatient and other visuals helped them to see
across two sites: Hilton Special School staff. For our final workshop, we ran how they could practically implement
and another site which hosts the a very practical session where we this into their own classrooms.
Hilton Early Intervention Centre, Hilton simulated a play group session. Everyone
Throughout this week, and during
Hostel and Outpatient Clinic. They took on a role of either child, staff
the last year of partnership, a lot has
provide speech-language therapy, member or parent to practise the skills
been accomplished. Despite this,
physiotherapy, occupational therapy, we had taught them over the previous
there is still a huge need for ongoing
audiology, social work and a range of three days. We observed their play and
therapy services particularly around
other support to the wider community. then had them “pause” so we could
AAC (augmentative and alternative
coach them how to implement extra
communication) and assistive technology.
ideas. Then we would say “play” and
observe them putting those ideas We would like to thank TalkLink Trust
into action. Everyone enthusiastically and Frank Hilton Organisation for
modelled using the core boards, their financial support and especially
indicated that activities were finished Shelley, whose enthusiasm made this
on the visual timetable and made trip happen. We would also like to
communication fun! There was a lot of thank Terri Walker, an Australian speech
laughter despite the 40° plus heat in pathologist, and other therapists who
the training room and it being late in have worked with staff at the Frank
the day when people were feeling tired. Hilton Organisation for years before us
The feedback from these sessions was and have provided the platform which
positive: teachers requested their own we were able to add to on this trip. •
Communication Matters • 17Members’ queries and comments
Jodi White, Member networks / Tūranga whatunga mema portfolio holder, membernetworks@speechtherapy.org.nz
Board portfolio positions support the group and enable your
Q: How do you appoint portfolio clients or family members to join
holder positions in between AGMs? the group or contribute and receive
information. Please also see the Spring /
A: There is a protocol whereby a member Kōanga 2019 edition of Communication
can be appointed into the role until Matters for an update from Geneva
the next AGM. When the AGM comes Hakaraia-Tino, the Consumer Group
around there is a call for nominations Lead. Please contact Shannon Hennig
Kia ora koutou, and the usual process is followed. communications@speechtherapy.
I hope you’re enjoying summer. For me org.nz for more information.
Conference 2020
2019 was super busy but also filled with
exciting opportunities. I was thrilled to Q: Is there is an overarching topic? And Giving Voice Aotearoa
represent NZSTA at the IALP conference when there will be a call for papers? Q: Would it be better to have our
in August and attend the combined A: The theme has been finalised – look Giving Voice Aotearoa Week of
NZSTA and SPA conference in Brisbane out for advertising. The call for papers Action at a different time of year?
in June, as well as all the board and area will be sent out in early 2020, we will September seems to be a time when
meetings.I am very proud to be a part of give you notice and information in the many similar initiatives are in place.
such a strong and vibrant association. new year. A: We feel that having our awareness
I wish you all the best for the holiday Q: Can we invite one or two local campaign at a similar time to Te Wiki o
season and look forward to everything people with lived experience Te Reo Māori (Māori language week) is a
there is to come in 2020. to speak at the conference? great combination, but we are looking
at moving the week to be adjacent but
Nāku noa, A: This is in discussion and we are not overlapping. Watch this space!
Jodi working towards this if possible.
Q: We would love some more info
Consumer group on what being a champion involves,
Q: How often do meetings occur? including the terms of reference.
And is there an information sheet to A: Please contact Shannon Hennig
give out to families? communications@speechtherapy.
A: We always welcome new members org.nz for more information about
to the consumer group. We will update what being a champion involves.
the website to explain how you can
18 • Communication MattersGeneral We are re-looking at the options for are doing as an association to promote
Q: One member shared how much part payments and are going to try awareness and fight for access to services
pride she feels about the profession our best to accommodate this. If this is for people with DLD? Can we develop
seeing her colleagues wear their pins on an option you want to pursue, please some New Zealand-specific videos
their lanyards at work. Could we do an contact the admin team, even if you for DLD awareness day next year?
order of pins every few years, perhaps have been in contact previously.
A: In 2019, there was a huge push to
at conference time, to promote the field Q: We would love a breakdown of promote awareness and discussion
and take our pride in our profession? registration fees and how these are used. around DLD, particularly on Facebook
A: There is a significant cost attached and Twitter. We are aware that not
A: This information is included in the all members use social media so we
to the pins. There was a special annual report and communicated at
occasion last year on the signing of will continue to look at other ways
the AGM. You can find copies of the of disseminating this information.
the self-regulation document. We are annual reports and AGM minutes when
looking at ways that new members you login into the NZSTA website Maintaining competence and 1000
and those without pins can get them. under executive documents. hours requirement for membership
Membership fees Q: How are negotiations going with Q: Concerns were raised for people on
Q: Many members strongly suggest the Ministry of Education (MOE) family leave or dealing with health issues.
offering an instalment plan for paying. around paying membership fees? Is there a chance of having a provisional
Some are happy to pay in advance Is there any chance that it can be status or returning practice framework?
so that they are paid in full by the end coordinated with when our next round A: See the membership categories
of the year for the following year. In of membership fees will be due? outlined on the NZSTA website. Be
other words, paying 2021 fees over aware that you do not need to have
A: Unfortunately, we are unable to
the course of 2020 in quarterly or direct contact hours, indirect hours count,
provide further feedback at this time, but
monthly instalments. Others would e.g., you can be working in management
we can assure members that high-level
not be happy paying in advance (i.e. or advocacy. There will not be a change
discussions are being held at MOE
twice the costs in one year) and feel to our policy. Please continue to check
with this being the ultimate outcome.
that with rise of dues, instalments are the NZSTA website for details. NZSTA is
important, as had been discussed and Developmental language in line with other associations in terms of
promised was possible (with individual disorder (DLD) our requirements, therefore it is essential
arrangement) at private practice forum. that recency of practice is demonstrated.
Q: One member who is relatively new
A: This is quite a complicated option for to New Zealand commented at how
us. We are aware that some people have little discussion about DLD she is seeing
made contact and been turned down. in our area. She is wondering what we
Communication Matters • 19You can also read
