A Little Less Conversation

The thinking spot of a Linguistics and English Language graduate with a passion for language development, speech pathology and communication disorders.

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Employers Stammering Network

Image from BSA - ESN Launch

9th May marked a monumental occasion in the field of stammering: the launch of the Employers Stammering Network (ESN).  The innovation, launched by the British Stammering Association with the help of Ernst and Young and Ed Balls MP - who is himself a person who stammers - aims to provide employers with information on how best to recruit people who stammer and support employees who stammer.

Last month (25th April 2013), I blogged about my experiences at a local stammering support group and reported that one member in particular felt that her stammer had held her back in interview situations and was often the main reason she felt she had not been offered a job.  This may have been due to the fact that prospective employers were ill-equipped in understanding stammering and the best way to support people who stammer in order to provide them with equal job opportunities.

Organisations can join the ESN for an annual membership fee, which will entitle them to a whole range of resources that aim to quash the misconceptions surrounding stammering and address certain issues that will be of benefit to both the person who stammers and, thus, the organisation as a whole by being more open and understanding.

This ESN brochure explains more about the network in detail.

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Everyday, Non-Verbal Communication

I'm just writing a quick post today after a thought that occurred to me while I was having my car washed this afternoon.

We sometimes don't realise just how important gesture can be to sending and receiving communicative messages.  In the situation I was in today, the car wash employee and I were unable to engage in conversation through the closed windows of my car, yet the whole transaction was easily completed purely through gestured signals.  I was able to tell the man which treatment I wanted and he was able to tell me the price, where and when to move the car and when to stop through simple hand gestures.

Something like car washing is a regular, mundane activity that we don't often give much thought to but it just shows how far gestures actually go in communication and how useful non-verbal communication can really be!

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AAC Systems for Children with Learning Difficulties

I have been carrying out some work experience in a brand new - and totally amazing - school for children with learning difficulties in my area for the past two weeks.  Although I don’t have time to blog about all the fun things I’ve been up to with the children, I thought I would discuss several systems of AAC (Augmentative and Alternative Communication) that the school have in place to support the needs of the children.

1. Colourful Semantics

This system was developed in the UK as a means of promoting sentence building and correct use of structure.  The idea is that children use picture cards - which are colour-coded for subject (‘who’), verb (‘what doing’), object (‘what’) etc. - and construct sentences by selecting appropriate colours.

2. Talking Mats

Talking Mats is a communication tool which is based on the organisation of picture cards representing different objects or activities on a mat.  This allows children to visually express thoughts and requests easily by allocating them to specific categories such as 'like' and 'dislike'

3. Objects of Reference

The Objects of Reference strategy is used throughout the school to facilitate communication. The system uses physical objects to represent particular meanings associated with them.  For example, a cup could be used to symbolise thirst and deliver a request for a drink.  Objects of Reference can also be used to introduce an element of choice in the child’s communication by allowing them to point at a specific one in a selection.  The system is useful in representing abstract ideas such as ‘love’ or ‘happiness’ since consistant use of a certain object - even if it is not directly related to an idea - can gradually come to represent it over time.

Finally, the school has a fantastic system in place whereby each child carries a communication passport with them at all times.  This is a small booklet which contains information about their communicative needs, interests and background that can be accessed by play group leaders, bus drivers and anyone else who may come into contact with the child.  I think this is a superb idea; although the child cannot tell others about the things contained in the passport, they are able to find out appropriate topics of conversation or best methods of communicating with each individual child and focus on what works best for them.

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Visiting A Stammering Support Group

I haven't blogged in a few days because I've had a really busy week, which included starting two new ongoing voluntary posts! However, I thought I'd take time out of my schedule to write about my experience observing a local stammering support group a couple of days ago.

I have mentioned the brilliant Stuttertalk podcast a few times on this blog but I've never actually had any experience in meeting people who stutter (PWS) or chatting to them about the challenges they face and the help they receive.  In fact, the lady who holds the group told me there are only two stammering support services in the whole of the north-east of England - a worrying statistic that really ought to be addressed!

During my time at the group, I learned many things about stammering that I didn't already know including the ratio of PWS is 4:1 in men and women respectively.  It was also interesting to discover PWS can have good and bad days with their speech and it is not necessarily the same words on which they block.

Some of the issues we discussed were talking to family members about stammering; almost all of the PWS said that they either had not discussed the fact that they stutter with close family members or that they had great difficulty in doing so for fear of being thought differently of. We also discussed interview situations and whether or not PWS would mention that they stutter to the interviewer.  Most of the group said they would not normally mention it and one member said that she often feels like her stutter has been used against her in interviews and has been the reason that sometimes she has not been offered a job.

Another issue we discussed was talking on the telephone.  The group was split on this: some members stated that they hated speaking on the telephone in case they blocked and the person on the telephone lost patience with them.  On the other hand, some PWS said they didn't mind the telephone because being unable to see the person they are speaking to means that they can't see their facial reactions if they are embarrassed or uncomfortable.

I asked the group about their opinions on voluntary stuttering and whether or not they employed it as a strategy in their speech.  (This blog post from 5th February 2013 explains what the technique is all about).  Although the group often practises voluntary stuttering in the sessions, none of them actually use it in their speech.  The main reason for this was because it was too big a step to deliberately stutter when they have been trying so hard to avoid or hide it for so long.  However, one of the group members said that she really enjoys using the easy onset method of avoiding blocking.  This method relies on prolonging the sound at the beginning of a difficult word to gradually ease into it without stuttering.

Overall, I thoroughly enjoyed attending the group as it was a brand new experience for me and it was very interesting to see a whole different side of communication difficulty!

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BBC Radio 2's Voice Week: Losing Your Voice

I got a nice surprise when I tuned into the Jeremy Vine show on BBC Radio 2 yesterday afternoon, as his programmes this week are part of 'Voice Week' and focus on different aspects of the human voice.

Yesterday, Jeremy discussed the impact that losing your voice can have on everyday life.  His first guest was Connie Fisher, a West End performer who was recently diagnosed with a condition that means she has holes in her vocal cords, leaving her unable to reach the high notes that she once could and reducing her vocal range dramatically.  Her speaking voice also sounds hoarse and raspy.  Whilst her condition - which the doctors told her she has had from birth - has left her unable to do what she loves, Connie described how it has made her aware of many people whose basic communication has been impaired through different conditions that can lead to loss of voice.  She explained how she often feels socially restricted: she avoids going to loud parties or restaurants for fear of not being able to vocalise loud enough to be heard in conversation.  She also described how if she ever had children she would be unable to shout at them to alert them of potential dangers like a car coming down the road.

Jeremy also took calls from listeners who have conditions affecting their voice quality.  It was clear from the first caller that she struggled significantly to even make a vocalisation, which obviously has a huge impact on her daily life.  She mentioned how she could not communicate with shop workers to ask about certain items because they would not hear her or understand what she was saying.  Another caller told the listeners that she had lost her voice seven times in periods of up to two years and someone else described how nodules on her vocal cords left her unable to communicate her message during a 999 call when her daughter was taken ill as the emergency services could barely hear what she was saying.

However, one of the messages of hope came from a listener who had lung cancer and lost her voice for a year as a result.  She described that with the help of a speech and language therapist she eventually got her voice - and the ability to communicate - back without the need for surgery.  That's just one of the reasons why SLTs are so important!

Yesterday's programme can be listened to here but hurry because it is available for one week only (and it is well worth a listen!)

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Stop The Bus, Dominos and Flashcards

I spent the morning with my lovely clients of one of the Stroke Association communication support groups which was back up and running after a month's hiatus.  I thought I'd use this post to describe the different activities we completed and the various areas of language they targeted:

1) Stop the bus

The first activity we worked on was a slight variation of the popular game 'Stop the Bus'.  The game consists of several different categories, such as 'girl's name', 'country', 'animal' and 'fruit', and the aim of the game is to think of words that fit into each category beginning with your chosen letter of the alphabet.  Whoever completes all the categories first shouts 'stop the bus!' and everyone compares the answers they gave with each other.  However, to reduce the pressure and the competitive nature of the game, we decided to take our time and think carefully of suitable answers for the letters <a> and <b> together.

This task really helped with word-finding because I was able to give my client clues to possible answers to jog his memory.  We also found that using a letter chart communication aid to spell out words gradually helped with word retrieval.  During the task, my client practised spelling by writing down each word and I was really impressed with what little help he needed from the letter chart! We also practised pronunciation by repeating the words we came up with several times after we had chosen them.  We found that the game really challenged our brains to come up with suitable words to fit the categories!

2) Dominos

The next activity we attempted was using domino-style flash cards to practice numeracy skills, remembering words for numbers and pronunciation.  I asked my client to count the number of dots on each domino and say how many there were in total, however, his numeracy skills were very advanced so we didn't need to spend much time on this! We did use it to practise articulation of the number words though.

3) Famous Faces

Our second set of flash cards were famous faces from the past.  We went through the pictures and my client told me who the person was and what they were famous for.  Again, this helped with word finding and we found that gestures were helpful when my client couldn't remember the words (e.g. gesture for 'bowler' and 'cricketer').  He managed to teach me a thing or two about some of the old celebrities on the cards!

Finally, we had our traditional quiz at the end of the session where we had a set of 20 questions and 20 one-word answers to choose from, which was pretty taxing on the brain! Overall, the clients (and volunteers!) worked really hard this morning and we celebrated their progress with tea and biscuits.

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Talking About Health

I have been volunteering for Headway UK for around a month now and have really enjoyed working with such a wide range of adults - young and old.  For those of you that don't know, Headway is a charity that specialises in helping people with brain injuries.  I have been going along to some of the local group sessions in my area to help out.

Today, the theme of the session was health and nutrition.  The clients enjoyed making (and eating!) a pudding of muesli, natural yoghurt and blueberries and discussing which foods are essential for a balanced diet.  We also held a quiz based on keeping fit and healthy, which was taken from the NHS website and can be found here.  Some of the questions really gave us food for thought and sparked some interesting conversations amongst the members of the group!

I thought it would be nice to share what activities we had been up to on the blog to give anyone who is interested in volunteering for Headway or anyone who is looking for brain injury support groups an idea about what is available out there and what you could get involved in! Although the communication problems of this group are at various intervals along the spectrum and the group does not specifically target communication rehabilitation, it's clear to see that the clients enjoy speaking with like-minded individuals and interacting through the activities we run.

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Tackling Post-Stroke Communication Rehabilitation in Different Support Group Settings

For the past couple of weeks, I have been attending a different communication support group to the normal one I work for with The Stroke Association in order to see how the two groups differ in their post-stroke communicative support.

I was initially quite shocked at the differences between the two groups! The one I usually work for (Group A) relies on one-to-one activities between volunteer and client, whereas the other group (Group B) focuses on group interaction between clients.  Group B also incorporates the fantastic speech and language apps that are available through iPad to give clients the opportunity to take part in more therapy-centered activities rather than general conversational discussion.

Today, I worked with a client on the iPad using an app named Speech Sounds on Cue for iPad. Unfortunately, the app is based on US English but it still offers some useful tools for practising the phonemes of British English.  I found working with the iPad a useful diagnostic tool; it was easier to pick up on the parts of the client's speech that needed work when going through the activities than by listening to general dialogue.  The client I worked with today had severe aphasia and was relearning the speech sounds /b/, /ʃ/ and /w/.  However, she demonstrated signs of perservation - a phenomenon I have mentioned before whereby the client becomes fixated by a word and will repeat it in successive exercises rather than producing new words.  This was quite challenging because, although she was producing the correct sounds, when she had mastered a word she would repeat it in the next sentence instead of producing the new sounds.

I really enjoyed visiting Group B and found it insightful to observe how different CSG co-ordinators tackle the same issues in different ways.  My experiences have definitely given me food for thought for when I return to Group A next week!

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The McGurk Effect

I decided to use today's post to share an interesting phenomenon I came across during my time as a linguistic undergrad: The McGurk Effect.

Have a look at the video below:

The McGurk Effect displays the interaction between visual and auditory information in the perception of speech as a whole.  When the visual aspect of one phoneme is paired with the auditory aspect of another, our brains interpret the information as a third sound.  I find it fascinating that we can perceive the same sound as three different ones according to which information is presented before us.

The McGurk Effect explains that when the brain is presented with conflicting information, it perceives something which is intermediate between the two as a 'best guess'.  Speech recognition in everyday conversation for people without visual or hearing impairments relies on the interaction between what is seen and what is heard.  When the auditory information is of poor quality, such as in a loud restaurant or club, and the visual information is of good quality, the McGurk effect can manifest and make you 'hear' a sound that your interlocutor is not actually producing!

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The Stroke Association North East Volunteer Conference 2013

Having been a volunteer for The Stroke Association for around five months now, I was really excited to attend the North East Volunteer Conference in Durham this morning.

Due to the snow (in March!) the workshop on visual impairment led by a rehabilitation worker for Blind Veterans UK - the event that I had been most looking forward to - had to be cancelled but that didn't stop the morning being interesting and insightful.

The conference opened with a brief overview of the up and coming services that the association is developing within the north east region.  These include a peer support network, a strong focus on stroke prevention and early stroke support to reduce the number of cases of hospital readmissions and the Aphasia Expert Patient service, which comprises a group of fully-trained stroke survivors who help to raise awareness of the effects of aphasia and support fellow stroke survivors who suffer from the condition.

The guest speaker of the morning, Dr Satinder Sanghera, delivered a powerful and thought-provoking talk on her role as chair of the Durham Dales Clinical Commissioning Group and her battle to overcome the debilitating effects of the stroke she had as a second-year medical student aged just 20 years old.  Dr Sanghera explained how there was very little post-stroke support when she had her stroke in 1986 and doctors told her that she would never be able to return to medical school.  However, sheer determination led her to regain the ability to walk and talk again and eventually qualify as a doctor, proving that there is life after stroke, despite the many struggles that accompany it.  (Read more about Dr Sanghera's inspirational story here and here.)

Another great part of the day was getting the chance to hear about the work of other volunteers and what they have achieved in their various clubs and groups.  It was enlightening to find out how different all of the groups are from each other, despite focusing on the same common goal of improving life after stroke.  It was also useful to have an insight into the independent stroke organisations in the region outside of The Stroke Association and the fantastic help and support they provide for stroke survivors from all walks of life.

Finally, the conference provided a snapshot of the amazing work the fundraising team do to generate funds for the charity in order to maintain and protect its valuable services.  There are so many fun (and challenging) events coming up in the area, such as a 26 mile coastal walk from Bamburgh to Alnmouth and a zip slide from the Tyne Bridge, which will hopefully help to raise the essential money that is needed for the work to continue.

I will sign off with an inspirational quote that formed part of Dr Sanghera's speech:

  Together, we can fight against stroke.

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Sign Language Interpretation and The Live Music Experience

Image from NY Times

Imagine never being able to hear the music of your favourite band ever again.  Never being able to be part of the unity of the chanting crowd at a festival.  Never being able to feel the emotion as your favourite lyrics are thrust from the stage.  Without the ability to hear, the communicative messages and emotional experiences of music are completely lost.

Or are they?

Barbie Parker, a native of the USA, is a sign language interpreter whose job it is to interpret bands' sets for deaf and hearing-impaired festival-goers.  Not only does she sign the lyrics, but she opens doors to a different kind of musical experience for those with hearing problems by playing air guitar and drums and getting into the groove of the bands for whom she signs.

Many festivals, particularly in the USA, are beginning to incorporate sign language interpreters into the events as a way of promoting inclusion and bringing together music lovers from all walks of life.  Ms. Parker's company, LotuSIGN, has delivered ASL interpretive performances at US festivals such as Lollapalooza in Chicago and South by Southwest in Austin, which have been positively received by the deaf community.

This story brings along a positive and hopeful message for the future: being deaf does not necessarily prohibit access to the world of live music events and the emotional experiences that accompany it.

Read the full story about Ms. Parker and live music signing through The New York Times website here.

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Twitter Tribes and Communicative Idiosyncracies

Today, I read an interesting article on The Guardian website, which discussed communication and language choices on the social networking site Twitter.  According to new research, tweeters are forming online communities or 'tribes' based on the language they use, as well as spelling and grammar.

The research found that the Twitter tribes are based on cultural backgrounds, political interests and hobbies and members and each have their own idiosyncratic communicative traits.  For example, fans of Justin Bieber tend to use words ending in -ee, such as 'pleasee'. In addition, members of the African-American community tend to communicate by shortening the ends of words: -ing to 'in' and -er to 'a'.

These findings greatly contradict the idea that Twitter is used for sharing everything with everyone. Researchers hope that in the future new ways of communication between Twitter tribes will develop in place of the current hashtag feature.

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'Glue Ear' and Speech Development

According to the NHS Choices website, 'glue ear' is a 'common childhood condition in which the middle ear becomes filled with fluid' and it affects approximately one-in-five children around the age of two-years-old.  Glue ear causes hearing loss and, although most cases of it go away within three months, many other cases persist and start to interfere with the child's communication and speech development, often to the extent that the child requires the help of speech and language therapy for everyday communication.

At present, long-term cases of glue ear can be treated through minor surgery where fluid is drained from the ear through small tubes named grommets.  However, researchers at Cardiff University are hoping to trial a new oral treatment, which involves a week-long course of steroids that are already used to treat childhood asthma.  If such treatment is successful, it could have huge benefits for children with language impairments as a result of glue ear and reduce the need for unnecessary therapy.

BBC News released an article on its website on the subject, featuring a case study of a young girl whose speech and language was severely affected by glue ear.  Sarah Jones, explained how her daughter's inability to hear made her reluctant to speak in social situations since her speech was unintelligible and required 'translation'.

Oral steroids for glue ear would be a huge breakthrough for children whose speech development is being hindered by an easily-treatable condition.  Such treatment would reduce the need for surgery and the time spent being unable to hear and allow children to undergo a normal trajectory of language development.

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Brain-to-Brain Communication in Rats

Rats have been widely employed in scientific study to provide a window into human cognitive mechanisms and brain activity.  Recent ground-breaking research at Duke University Medical Center in North Carolina has discovered that the brains of lab rats can be connected by wired implants, allowing communicative messages to be transmitted directly through brain signals.

Professor Miguel Nicolelis described the procedure to the BBC Science in Action programme:

Image from BBC News website

  Two rats are placed in separate chambers to solve a simple problem: pressing a lever in correspondence with an indicator light being switched on above it to obtain a reward. One rat is the 'encoder' receiving the visual light cue and the other is the 'decoder' receiving no visual cue.

With training, the encoder learns to press the lever that matches the switched on light to receive a reward.

When the encoder presses the lever, a brain signal is sent to the decoder.

The decoder then interprets the brain signal it receives to press the correct lever and receive a reward.  If it does so correctly, the encoder receives an extra reward.

Professor Nicolelis described how the decoder rat was able to achieve a success rate of 70% after an hour's training per day for 45 days.  He explained that there is a moment in time when the decoder rat suddenly realises that it must rely on the cue that has been transmitted from the encoder via the brain-to-brain interface to achieve the correct answer and thus the reward.

On a further - and rather unsettling note - Professor Nicolelis believes that brain-to-brain communication is an idea that can - and will - be extended to humans in the future, meaning that humans could potentially communicate without the need for speech through direct brain-to-brain signals.  Although this is an exciting prospect for some scientists, putting electrodes directly onto brain sites is clearly very invasive and carries with it serious ethical issues; using the brain in such a computerised matter could leave it open to hackers who could steal information that is being transmitted via the interface! It hurts my brain just to think about it...

Read more about the story on the BBC News website.

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Talking on the Telephone After Stroke

This morning, I attended the Communication Support Group that I volunteer for within The Stroke Association. Aside from working on activities to improve post-stroke communication, we also get a chance to informally converse with the clients and discuss any problems, worries or concerns they might have.  One of the topics of discussion today was the challenges that people face after stroke in their everyday lives and how they can be overcome. One major concern for a lot of stroke survivors is talking on the telephone, even though their face-to-face communication is often really good.  The fear of being under time pressure to find the words and get them out over the phone can really knock the confidence of stroke survivors and many of them avoid using the telephone altogether for fear of being unable to express themselves.  After discussing this issue for a while, we tried to come up with suggestions as to how to alleviate some of the fear and anxiety that conversing via the telephone can bring, such as the person on the other end being impatient because they don't understand that they are talking to someone who is recovering from stroke.  Some of the suggestions involved explaining to the person on the line that you have had a stroke and asking them to bear with you; this alleviates stress on both parties as they are both aware of the situation and are able to deal with it better.  Another suggestion was to practise calling people on the telephone and getting used to speaking to them without being able to physically see them.  Many people fail to realise how difficult tasks we see as simple in our lives are for stroke survivors and it is really important for us to encourage them to regain their independence by celebrating the fact that they have survived such a terrible attack and are displaying incredible courage in overcoming it!

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Michael Haneke: 'Amour'

I've always been a fan of Michael Haneke's film-directing style; he doesn't dress up the issues he tackles in fancy cinematographic effects, instead opting for more stark shots of what can often appear as rather mundane sequences but which can stir up emotions that seem even more real.  That's why I was interested to see how his latest offering, Amour, winner of the Palme d'Or at the Cannes Film Festival 2013, portrayed the effects of stroke on the everyday lives of an ordinary, octogenarian couple.

The story follows elderly French couple, Anne and Georges, who are both retired musicians living in Paris.  They do ordinary things together like listening to music and going to concerts until, one morning, Anne has an episode at the breakfast table and it soon becomes clear that she has had a stroke.  

The journey that Haneke takes us on focuses on how the couple, both as individuals and together, struggle to come to terms with ageing, illness and, ultimately, death.  Anne's first stroke brings with it right-side paralysis but her ability to communicate remains in tact, allowing her to interact with Georges as she has always done and to express to him her fears and anxieties of post-stroke life.  However, when Anne suffers a second stroke, her capacity for conversation and motor co-ordination is severely impaired, which is extremely hard for the family to come to terms with.  Georges' reaction to this is to hide Anne away from their daughter, who breaks down in tears when she realises her mother can now speak only 'gibberish'.  Georges becomes increasingly frustrated as he struggles to accept that the woman he has spent his life with can no longer interact with him and needs around-the-clock help to complete even the simplest of everyday tasks.

Haneke portrays the trajectory of post-stroke life in an eye-opening and heartbreaking light. The title of the film is rather apt; love is what drives Georges' ultimate decision as the film draws to a close.  I'm reluctant to discuss any spoilers with those who have yet to see the film so I won't go into too much detail, however, I will say that Amour is extremely well-executed with stunning performances from Jean-Louis Trintignant (Georges) and Emmanuelle Riva (Anne) and provides a powerful interpretation of the unforeseen strain and pressure that stroke can have on a family.

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Bupa's 'Talking Toolkit': Communicating And Dementia

One area of communication in which I am particularly interested, having had first-hand experience of it within my family, is the progressive difficulties which manifest in people with dementia.  Most people think of dementia in as simple terms as 'memory loss' but its ramifications for communication and interaction can be monumental, resulting in the inability to engage with an interlocutor or to express thoughts and feelings.

I often express my passion for providing help and support for the families and carers of the individual who has communication problems, which is why I was delighted to stumble across Bupa's Talking Toolkit: a readily available booklet that provides advice on 'how to keep communicating with a loved one as dementia progresses'.

The toolkit provides simple and helpful information on what can often be a daunting, isolating and frightening condition.  It describes the 'dementia journey' in terms of four main stages, giving tips on communication for each stage:

1. Memory Loss and Confusion

Keep conversation brief

Focus on what's important

Don't ask open questions

Speak clearly and avoid anaphora

Be patient

Reduce anxiety

2. Challenging Behaviour

Help the person retain control

Give clear and helpful instructions

Be flexible and understanding to their world

3. Losing a Grip on the Present

Don't contradict the person with dementia

'Join their world'

Don't feel guilty about saying things that aren't true

Try to centre the conversation around something they love or something familiar

Use memories to engage in conversation

Remember that the person may not feel like communication sometimes

4. Physical Frailty and Dependency

Show them how you feel with gestures

Maintain eye contact

Look for physical cues as communicative messages as to how the person is feeling

Use images as communication aids

As well as leading readers through the four stages, the toolkit also provides answers to questions that are commonly asked by the families and carers of people with dementia.

I believe resources such as the Bupa Talking Toolkit are invaluable for providing support for people who are thrust into a scary world in which they never thought they would find themselves.  Most importantly, they demonstrate that communication can take a vast number of varying forms, making it possible to maintain interaction with people who have progressive conditions like dementia.

Click on the picture above to access the Talking Toolkit.