BACKGROUND Many amateur singers enjoy singing in choirs. They are likely to lack the training and expertise of professional singers and this may have an impact on their vocal health. AIMS To assess the experiences of amateur singers, their use of warm-up and cool-down sessions, their vocal health, their sources of help and advice and their reactions to receiving a diagnosis and treatment. METHODS AND PROCEDURES A questionnaire was sent to amateur choir singers. Quantitative data on their use of warm-up and cool-down activities were collected and the singers rated how frequently they experienced adverse voice symptoms after singing. Qualitative data were collected from singers who had sought advice about their voice and from those who had received a diagnosis and treatment. OUTCOME AND RESULTS Most choirs used warm-up sessions but few used cool-down. Singers who participated in choir warm-ups experienced significantly less vocal symptoms. Individual warm-ups were ineffective. Singers who had previously had a diagnosis continued to have significantly higher symptom scores. A quarter of the singers who had neither sought help nor had a diagnosis had high scores. Singers appeared uncertain about who to consult for help. Those who saw a speech and language therapist were much more likely to receive a diagnosis and treatment either by the therapist or by referral to an ear, nose and throat specialist. Those receiving treatment were mainly positive about it and likely to complete a course of therapy. CONCLUSIONS AND IMPLICATIONS Warm-up sessions performed by choirs are helpful in avoiding voice symptoms and are recommended. The presence of singers who are unaware of potential damage to their voices is a concern. A simple rating system, as used in this research, may act to alert them to the dangers. Choir leaders could be more active in advising singers and refer them to professionals where necessary. Speech and language therapists appear more sensitive to their problems and could be a first point of contact. WHAT THIS PAPER ADDS What is already known on this subject Poor vocal health may occur in amateur singers and lead to voice disorders which will reduce the demonstrated benefits of regular singing. They may be less aware than professional singers of potential hazards and may not know how to sing in a way that ensures good vocal health. There has been less research on the extent of voice problems in amateurs or of the actions they may take to resolve the vocal difficulties they encounter. What this paper adds to the existing knowledge This survey demonstrates that choir warm-ups were effective in helping to avoid common symptoms associated with voice problems. A large minority of singers who had not sought help for voice problems had high symptom scores on our assessment. Singers frequently turned to a singing teacher for help. Those who consulted a speech and language therapist were much more likely to be referred for further investigation and treatment. What are the potential or actual clinical implications of this work? We present a simple subjective measure of symptom severity which succeeds in distinguishing between singers who warm up their voices and those who do not and between singers who have received a past diagnosis and those who have not. There are a number of indications in this research that amateur singers are unsure if they need help and are uncertain who can offer it. In these circumstances the use of a simple measure of the severity of vocal abuse may be useful.

Background Conversation is challenging to measure. Quantitative and qualitative measures need to be sensitive to the conversation context, the purpose and the variable contributions of participants in order to capture meaningful change. Measurements also need to be consistent across independent raters. The reliability of global observational rating scales across differing sample lengths has previously been investigated. An investigation into the effects of sample length on inter-rater reliability using a behavioural frequency measure is a new field of research. Aims This study reports on the inter-rater reliability of the Interactional Network Tool (INT), a behavioural coding system for use with group interaction data. It examines the effects of sample length on reliability using a refined coding system designed to improve the speed and efficiency of use in clinical settings. Methods Fourteen video samples of group interactions for people with acquired brain injury were prepared for analysis. Two raters independently coded the films using the INT coding system. Individual code reliability was calculated using intra-class correlations (ICCs). Codes were combined to form a new coding structure. Reliability of the new codes was calculated using intra-class correlations across four sample lengths (5,10,15 and 20 minutes). A one-way analysis of variance was used to compare the means of the four sample lengths. Outcomes and Results Acceptable inter-rater reliability was achieved using the refined INT coding system. There was no difference between the four sample lengths. Conclusions These findings indicate that trained clinicians using the INT in clinical practice can achieve a reliable measure of participation in a group interaction from short samples. Validation with other clinical groups is now indicated.

Background Social communication impairments following acquired brain injury (ABI) are well-documented. There is evidence that group interventions are beneficial but research into validated instruments to measure group outcomes is a new field of investigation. Aims This study reports on the inter-rater reliability of three established social communication measures for use with group interaction data: the Profile of Pragmatic Impairment in Communication (PPIC), the Behaviorally Referenced Rating System of Intermediate Social Skills (BRISS-R), the Adapted Measure of Participation in Conversation (MPC). Inter-rater reliability of the Interactional Network Tool (INT), a new digital tool designed for group interactional behaviours, is also evaluated. Method Thirty-one video samples of ABI group interactions were independently rated by two rater pairs using the four outcome measures. Inter-rater reliability was calculated using intra-class correlations (ICC). Results ICC estimates and their 95% confidence intervals were calculated for the different measures. The measures showed differential sensitivity. Rater agreement on the MPC interaction (ICC = 0.77) and transaction (ICC = 0.74) scales was moderate to good. The INT initiation frequencies (ICC = 0.83) were moderate to excellent and the INT response frequencies (ICC = 0.69) were poor to good. Poor to moderate reliability was achieved on the BRISS-R PCSS (ICC = 0.49) and PDBS (ICC = 0.50) scale and PPIC findings were moderate but showed presence of skew. Conclusion Acceptable reliability was achieved on two measures of participation (MPC and INT). The INT shows promise as a new method to characterise interactions and detect change in group communication behaviour.

Background: Reduced social competence and social integration following acquired brain injury (ABI) is well-documented. There is evidence that group social communication interventions for people with ABI and training for neuro-typical communication partners can be more effective than training the person with ABI alone. This study explores the effectiveness of a peer-led group intervention based on claims that peer models are a more powerful mechanism for learning and behaviour change than interventions led by a clinician. A peer-led training model for social communication has not previously been tested in ABI. Method: Twenty-four participants with severe ABI were recruited from a residential post-acute neurorehabilitation centre. An experimental parallel group design was used to compare a peer-led group intervention to a social activity group (usual care). A pilot study tested the feasibility of the approach followed by a main study. The groups ran for 8 weeks. A peer facilitator was trained in sixteen individual sessions over 4 weeks with a clinician. Behaviour was measured twice at baseline, after intervention and at maintenance. Four primary outcome measures, including the Adapted Measure of Participation in Conversation (MPC), and a newly devised measure of conversational interaction evaluated change in group communication behaviours. Results: Groups did not differ in baseline behaviour. There were significant differences in the treated group on the MPC and the measure of conversational interaction post-intervention. The treated group showed a more balanced interaction post-intervention and at follow-up. However, outcome measures showed differential sensitivity. Conclusion: There is preliminary evidence of advantage for peer-led groups in ABI intervention. The new conversational measure shows promise as a method to detect change in group communication behaviour.

Pre-school education has been greatly expanded in the United Kingdom in the last two decades and further expansion is planned. Its provision allows parents to take up employment thus increasing family incomes and it is expected to narrow the gap between socially disadvantaged children and their peers. The latter is important as studies have shown that many children start school with poor language skills which threaten their attainment. Studies of the effects of pre-school education on the progress of disadvantaged children have shown inconsistent results and nurseries have been criticised by Ofsted for failing to prepare children for school entry. Nurseries and their staff have been found to vary in quality and in the level of qualifications they have. The provision of evidence based programmes which nursery staff may be trained to use may represent one means of improving their ability and improving the outcomes for pre-school children. We report an effectiveness study of Early Talk Boost a programme for use by nursery staff to improve language skills in three year olds. Nurseries were randomly assigned to use the programme or to act as waiting controls (who received the intervention in the following term). Children were assessed before and three months later after the completion of the programme. The progress of treated and control children differed significantly. Age equivalent scores showed treated children had gained 4.93 months, control children had gained only 2.33 months. We conclude that Early Talk Boost can be effective in advancing the language skills of socially disadvantaged children and improve their school readiness.

Substantial evidence exists that social circumstances can affect children's language development. As a result many children in socially deprived areas start school with delayed language, which may persist and adversely affect their attainment. We assessed the language of children in seven reception classes in a London (UK) borough and followed the progress of children with English as their first language (E1L) and with English as an additional language (EAL) during their first 2 years at school. Significant differences were found between schools. The effect of social factors on performance was reflected in a high correlation between the mean language score for each school and the percentage of children in the school receiving the pupil premium. Many of the children with EAL had very low scores reflecting their limited exposure to English prior to starting school. Most of these children attended schools where children with E1L also had low scores increasing the demands on the schools and their teachers. Children who had low initial scores made modest but significant progress during their reception year but failed to improve further during year 1 despite having non-verbal ability appropriate for their age. These results support previous findings that social deprivation can seriously delay language development, and that many children start school with weak communication skills. They add to previous findings by showing that the level of delay may differ substantially across schools in the same borough, by reporting data on children with EAL and by showing that children struggle to improve their abilities in the first 2 years of school.

BackgroundChildren with developmental language disorder (DLD) frequently have difficulties with word learning and understanding vocabulary. For these children, this can significantly impact on social interactions, daily activities and academic progress. Although there is literature providing a rationale for targeting word learning in such children, there is little evidence for the effectiveness of specific interventions in this area for children with identified DLD. AimsTo establish whether direct one-to-one intervention for children with DLD over 9 years of age leads to improved abilities to identify, comprehend, define, and use nouns and verbs targeted in intervention as compared with non-targeted control items and whether or not the participants' rating of their own knowledge of the words changes with intervention. Methods & ProceduresTwenty-five children and young people with language disorder (aged 9;4-16;1) participated in the study: 18 with DLD and seven with a language disorder associated with autism spectrum disorder (ASD). Two assessments of different levels were created: a higher ability (less frequent words) and a lower ability (more frequent words). Participants' speech and language therapists (SLTs) decided which level would be the most appropriate for each participant. Four tasks were carried out as part of the assessment and the scores were used to identify which words each participant worked on. Participants received one 30-min session per week one-to-one with their own SLT for 7 weeks, plus a 5-min revision session in between each main session. During each of the first five sessions, participants learned two new words; the two final sessions were spent revising the 10 words which had been targeted. Outcomes & ResultsPost-intervention assessment showed an increase in scores for both treated and control words. However, progress on treated words was significantly greater than on control words (d = 1.07), indicating effectiveness of intervention. The difference between progress on targeted and control words was found both for nouns (d = 1.29) and verbs (d = 0.64), but the effect size was larger for nouns. Whether or not the participants had an associated ASD did not affect the results. The children's self-rating of their knowledge of the targeted words was also significantly higher than for control words post-intervention. Conclusions & ImplicationsThe intervention delivered one-to-one by the participants' usual SLT was effective in teaching new vocabulary to older children with language disorders. This shows that older children with language disorders can make progress with direct one-to-one intervention focused on vocabulary.

Extensive evidence exists that many children who experience early socio-economic disadvantage have delayed language development. These delays have been shown to exist when children start school and appear to persist through their education. Interventions that can help these children are desirable to ease the difficulties they have in school and to address the loss in human capital which these children represent. We evaluated an intervention (Talk Boost) to treat children's receptive and expressive language in the early school years. A between-schools design was used. Eighteen schools in socially deprived areas were randomly assigned to receive the intervention or to act as waiting controls. Children in reception classes and in Years 1 and 2 attended language groups. The evaluation used the standard procedure for the intervention. Teachers were given guidance on selecting appropriate children, and the intervention was carried out by teaching assistants; 180 children participated. Those with English as their first language and those learning it as an additional language increased their scores significantly more than did controls. Most of the children selected had significant delays, which did not diminish as they advanced in school. Despite their improvement the treated children remained behind the expected level for their age after the intervention. These findings add to previous evidence that intervention can help children who start school with delayed language. There appears to be insufficient awareness of the communication needs of these children and of their likely inability to access other areas of the curriculum as a result.

BACKGROUND:The inverse-care law suggests that fewer healthcare resources are available in deprived areas where health needs are greatest.AIMS:To examine the provision of paediatric speech and language services across London boroughs and to relate provision to the level of deprivation of the boroughs.METHODS & PROCEDURES:Information on the employment of paediatric speech and language therapists was obtained from London boroughs by freedom-of-information requests. The relationship between the number of therapists and the index of multiple deprivation for the borough was examined.OUTCOMES & RESULTS:Twenty-nine of 32 boroughs responded. A positive relationship between provision and need was obtained, suggesting that the inverse-care law does not apply. However, large inequalities of provision were found particularly among the more socially deprived boroughs. In some instances boroughs had five times as many therapists per child as other boroughs.CONCLUSIONS & IMPLICATIONS:The data reveal that large differences in speech and language therapy provision exist across boroughs. The reasons for these inequalities are unclear, but the lack of comparative information across boroughs is likely to be unhelpful in planning equitable services. The use of freedom of information in assessing health inequalities is stressed and its future availability is desirable.

Parent–child interaction therapy (PCIT) is widely used by speech and language therapists to improve the interactions between children with delayed language development and their parents/carers. Despite favourable reports of the therapy from clinicians, little evidence of its effectiveness is available. We investigated the effects of PCIT as practised by clinicians within a clinical setting. Eighteen consecutive children referred for speech and language therapy because of their delayed language were entered in the study. A within-participants design was used, and the procedure was similar to that used clinically. Blind assessments were conducted twice before therapy to monitor change without therapy and once after completing PCIT. Significant changes in a parent rating scale, the children’s mean length of utterance and the ratio of time of child to parent speech were found after the therapy. No changes were detected prior to therapy. The similarity of the design to clinical practice and the use of several clinicians suggest that the findings can be generalized to other settings and clinicians. These findings are a first step in evaluating PCIT; we now need to show that parents can maintain their newly acquired skills in interaction, and that this benefits their children’s communication.

Word finding difficulties are often seen in children with language difficulties. Their problem is readily observed and has led to investigations of its nature and encouraged attempts at intervention. Semantic errors in their naming suggest that their knowledge of items is poorly developed and that therapies to strengthen it may be effective. Twelve children between 7 and 11 years of age were offered 3 hours of semantic therapy in two 15-minute sessions per week for 6 weeks. The children had severe and complex speech, language and communication needs and all were in the bottom 5% for their age on a test of word finding. Two categories of items were treated. Each category was divided into sets of items that were directly treated, and items which appeared during therapy but were not specifically targeted. Categories and sets of items were counterbalanced across children. The children were blind assessed on naming the items before and after therapy and at a maintenance assessment 6 weeks after the treatment ceased. The children improved significantly on the treated items and on untreated items from the same category but not on items from the untreated category. Improvement was maintained at the maintenance assessment. Although results were significant, only medium effect sizes were obtained. These results add to the evidence that semantic therapy can help children with word finding difficulties. In assessing their clinical significance, the severity of the children’s communication problems should be taken into account.

It has been suggested that difficulties with tense and agreement marking are a core feature of language impairment. Hence, studies are required that analyse the effectiveness of intervention in this area, including consideration of whether changes seen in therapy sessions generalize to spontaneous speech. This study assessed the effectiveness of therapy based around Shape Coding in developing the use of the regular past tense morpheme -ed in two school-aged children with language impairments. It also considered whether participants benefited from additional generalization therapy in order to start using target forms in their spontaneous speech. The former was assessed using a sentence completion task and the latter by a conversational task with blind assessors. One participant improved markedly in sentence completion but did not gain in the conversation task until after the generalization therapy. The other made more modest gains on the sentence completion task and seemed to generalize to the conversation task without recourse to the generalization therapy. Larger studies are required to confirm these interpretations and to determine whether they are applicable to the wider population of children with language impairments.

Objective: To investigate the impact of the phonetic content of two sentence sets on speech outcomes, specifically the effects of nasal phonemes. Method: Audio-video recordings of a consecutive series of 15 participants (age range 4–22 years), with cleft palate (syndromic or non-syndromic), with and without velopharyngeal dysfunction were taken. Participants repeated Sentence Set 1 (with nasals across sentences) and Sentence Set 2 (without nasals except the three nasal target sentences) during a routine speech recording. Two experienced Specialist Speech and Language Therapists, blinded to the study’s purpose, analyzed participants’ speech using the Cleft Audit Protocol for Speech-Augmented (CAPS-A). On day 1, recordings included Sentence Set 1. On day 2, 23 days later, recordings included Sentence Set 2. Main results: The difference between Sentence Set 1 and Sentence Set 2 ‘total scores’ (sum of scores on all CAPS-A parameters) was significant. The Pearson Product Moment showed high correlation. A Wilcoxon test revealed a significant difference between Sets 1 and 2 on the hypernasality parameter, and this alone accounted for the significant difference in total scores. Conclusion: The inclusion or exclusion of nasal consonants in the sentence set significantly affected perceptual ratings of hypernasality but none of the other CAPS-A parameters, highlighting the need for further investigation into perceptual nasality ratings.

Background: Using gesture as a compensatory communication strategy may be challenging for people with severe aphasia. Therapy can improve skills with gesture, at least in elicitation tasks, but gains ar often modest. Raising the treatment dose with technology might improve outcomes.Aims: This feasibility study developed a computer gesture therapy tool (GeST), and piloted it with nine people who have severe aphasia. It aimed to determine whether practice with GeST would improve gesture production and/or spoken naming. It also explored whether GeST encouraged independent practice and was easy to use.Methods & Procedures: Pilot participants had 6 weeks practice with GeST, flanked by pre- and post-therapy tests of gesture and word production. Usability was explored through interviews and structured observations, and the amount of time spent in the programme was monitored.Outcomes & Results: Scores on the gesture test were evaluated by 36 independent raters. Recognition scores for gestures practised with the tool improved significantly after therapy and the gain was maintained. However, gains were small and only occurred on items that were practised with regular therapist support. There was no generalisation to unpractised gestures and no effect on spoken naming. Usability results were positive. Participants undertook an average of 64.4 practice sessions with GeST, and the average session length was just under 14 minutes.Conclusions: GeST was proved to be easy and enjoyable to use and had some effect on participants' gesturing skills. Increasing the magnitude of gains would be desirable. The effect on everyday communication needs to be explored.

Purpose In this study, the authors investigated whether gesture, naming, and strategic treatment improved the communication skills of 14 people with severe aphasia. Method All participants received 15 hr of gesture and naming treatment (reported in a companion article [Marshall et al., 2012]). Half the group received a further 15 hr of strategic therapy, whereas the remaining 7 participants received no further input. The effects of therapy on communication were assessed with 2 novel measures. These measures required each participant to convey simple messages and narratives to his or her communication partner. In both assessments, a subset of the stimuli featured items that had been targets in gesture or naming treatment. Results Performance on the communication measures was stable over 2 baseline assessments but improved after gesture and naming treatment. Those participants who received additional strategic therapy made further gains on the message but not on the narrative task. Communication gains were not specific to the stimuli featuring trained items. Conclusions This study suggests that gesture and naming treatments can benefit interactive communication. The additional benefits of strategic therapy were less clear-cut but did have an impact on the transmission of simple messages. Gains seem to reflect the development of general communication skills rather than the use of trained gestures and/or words.

Telephone interviews and postal surveys may be a resource-efficient way of assessing health-related quality-of-life post-stroke, if they produce data equivalent to face-to-face interviews. This study explored whether telephone interviews and postal surveys of the Stroke and Aphasia Quality of Life Scale (SAQOL-39g) yielded similar results to face-to-face interviews. Participants included people with aphasia and comprised two groups: group one (n =22) were 3-6 months post-stroke; group two (n =26) were ≥1 year post-stroke. They completed either a face-to-face and a telephone interview or a face-to-face interview and a postal survey of the SAQOL-39g. Response rates were higher for group two (87%) than for group one (72-77%). There were no significant differences between respondents and non-respondents on demographics, co-morbidities, stroke severity, or communication impairment. Concordance between face-to-face and telephone administrations (.90-.98) was excellent; and very good-excellent between face-to-face and postal administrations (.84-.96), although scores in postal administrations were lower (significant for psychosocial domain and overall SAQOL-39g in group two). These findings suggest that the SAQOL-39g yields similar results in different modes of administration. Researchers and clinicians may employ alternative modes, particularly in the longer term post-stroke, in order to reduce costs or facilitate clients with access difficulties.

BACKGROUND The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. AIMS To investigate the working practices and professional experiences of paediatric SLTs working in the UK through an online survey. METHODS & PROCEDURES The survey was conducted online using Survey Monkey. Therapists were alerted to the survey through the Bulletin of the Royal College of Speech and Language Therapists and by e-mails to national special interest groups. OUTCOMES & RESULTS A total of 516 clinicians completed the survey. A large majority worked in the National Health Service (NHS). A varied pattern of working was revealed. Most worked in several settings and saw a range of clients. A typical clinician spends less than one-quarter of their time giving direct therapy and more than one-quarter training parents and other professionals. Nearly half of respondents felt that their time could be better used. Too little time for direct therapy and the time required for administration emerged as their principal concerns. Most clinicians have specialist knowledge of particular client groups and spend more time with them than do non-specialists. Nevertheless, clients are more likely to be treated by a therapist who does not claim to have specialist knowledge of their condition than by one who does. The only clients for whom this is not the case are those with dysphagia. Eighty per cent of respondents felt that proposed changes to the NHS would not benefit the children they treat and there was widespread concern about cuts and the effects of general practitioner commissioning. Despite this, a large majority expected to remain speech and language therapists 5 years from now. CONCLUSIONS & IMPLICATIONS This survey provides an overview of the working practices of paediatric speech and language therapists. Its findings have significant implications for training and workforce development in the profession.