Human Communication Just how much do we take for granted? Margaret Walker MBE Several months ago Peter Bateman contacted me and asked if I could talk at one of these meetings about Speech Therapy as he thought that it would be of interest. I agreed, as I used to practice as a Speech and Language Therapist. As time went on I thought I ought to broaden the topic and in this way you would understand the need for our role. However I intend to begin with a brief overview about our profession. Let’s start with a definition. What is speech therapy? Speech Therapy is concerned with the management of disorders of speech, language and swallowing in children and adults. Page 1 of 35
This is the definition on the Royal College of Speech and Language Therapists’ website. It is carefully worded and does not give much information. “Management” is the key word. Perhaps after my talk you will appreciate this choice of word more because our work covers such a huge variety and complexity of communication disorders and social issues. Where do Speech and Language Therapists fit into to the Health Scene? Where do Speech and Language Therapists fit into the Health Scene? Speech and Language Therapists are Allied Health Professionals. They work closely with Parents, Family members, Carers and other professionals such as Teachers, Nurses, Occupational Therapists and Doctors. Often they are members of specialist medical / educational teams. We are described as Allied Health Professionals and currently there are 13,000 practising Therapists in the UK. Not a really large number to cover the current need which is estimated as being 2.5 million people in the UK with a communication disorder. Where do Speech and Language Therapists work? Speech and Language Therapists work in: • Community Health Centres • Hospital wards • Occupational Therapy Departments • Mainstream and special schools • Children’s centres • Day centres • Client’s Homes Page 2 of 35
I think this list is clear and does not need any further explanation from me, but, some of the places on the next slide may. • Courtrooms • Prisons • Young Offenders institutions • As members of specialist teams e.g. Cleft Palate, Dementia • Independently, in private Practice Courtrooms. In the last 10 years our Law Courts have seen the emergence of a new legal professional - the Court Intermediary. Many of them are Speech Therapists, though there are some other suitably qualified and experienced professionals who have been selected to fulfil this role. It was realised that there are certain victims in Court who are only able to express themselves and understand what is said to them through unique augmentative forms of communication. This need is outside of foreign language or sign language interpretation. The Court Intermediary role is to act as the conduit between the victim, and the Judge and the Prosecuting /Defence Councils. Specific training is necessary before any professional can be considered for selection. I was on the Working Party that defined both the selection process and the training. Prisons and Young Offender’s Institutes. Many prisoners and young offenders often have very poorly developed communication skills due to disruptive childhoods. There are a variety of reasons such as, poor parenting resulting in inadequate stimulation, inconsistent school attendance etc. Some are also illiterate. Others may have specific communication problems e.g. hearing loss which has gone undetected. Specialist Teams need no explanation, but just a word about Independent Private Practice. This is on the increase due largely to economic cutbacks which have led to a reduction in NHS provision. Page 3 of 35
Ironically, many private Speech and Language Therapists who were forced to leave the NHS service for this reason are now being bought back with funding from different NHS, Education or Charity Budgets! After qualifying I worked in the Out-Patients departments of two General Hospitals. My case load was tremendously varied ranging from Cleft Palate and ENT cases, communication disorders resulting from Strokes, Laryngectomy and other forms of neurological degeneration. I also worked in a large hospital institution for people with Learning Disability and also in a local special school and a National Autistic school. Finally towards the last twelve years of my professional career I had a unique part time position as Senior Lecturer at St Georges Hospital Medical School, London where my role was to increase the understanding of Medical Students and qualified Doctors about the needs of people with all manner of communication disabilities. I also designed the Makaton Language Programme which is extensively used all over the UK and in many countries overseas with children and adults with severe communication and learning disabilities. Now let’s take a look at the qualifications necessary in this country to practice. Speech and Language Therapists Qualifications All practising UK Therapists have to have membership of the Royal College of Speech and Language Therapists, (MRCSLT) the governing body in the UK. The College regulates standards, training and national policy for the profession. The basic qualification is a B.Sc Degree in Speech Sciences or Human Communication. Many SALTs will also have an M.Sc or PhD in Human Communication. I have a B.Sc and an M.Sc and was a Fellow of the College. The College was founded in 1945 with the merger of two society’s that had developed the profession that far. In 1999 it was awarded the right to use “Royal” in its title. Page 4 of 35
Did many of you see the film “The King’s Speech about George VI and the relationship he had with his Speech Therapist, Lionel Logue? We still use many of the same principals of therapy today that he used to support the King with his stammer. However we’ve now given up rolling around on the floor with our patients!! Lionel Logue was involved in the founding of the College in 1945 and in 1948, he wrote to the King informing him about the founding of College and asking him if he would consider becoming a Patro n of the College. (See copy of Lionel Logue’s letter). Page 5 of 35
As the Monarch cannot assume such a role, King George instead arranged for his wife, Queen Elizabeth, to be the Patron of College and she continued after his early death as Queen Elizabeth the Queen Mother until her own death. The current Patron is the Countess of Wessex. Since 1945, the work of Speech Therapists has grown so much that the training has also had to expand to accommodate the needs. B.Sc (Hons) in Speech and Language. (City University) Four year degree Involves the theoretical study of Human Communication and the factors that influence its development and those that interfere or are acquired. Subjects studied in depth Psychology, neurology, anatomy and physiology, linguistics and phonology, related disorders of cognition, language, speech production, hearing and ENT, research and evidence based practice methods culminating in student’s research project. Practical clinical experience is also included. Here is the current syllabus for the 4 year B.Sc in Human Communication to give you an idea of the range of subjects studied. Each year, the syllabus will also include practical clinical experience under the supervision of a qualified Speech Therapist in a variety of different environments. Let’s now look at the variety of communication disorders that we manage. What types of Communication Disorders do SALTs treat? Babies • Feeding and swallowing difficulties Children • Mild, moderate or severe Learning Disability • Physical disability • Language delay • Speech and language impairment • Specific sound production difficulties Page 6 of 35
Some will be present from birth, such as, Learning Disabilities, Cerebral Palsy, Autism, Cleft Palate. • Hearing impairment • Cleft Palate • Stammering • Autism and spectrum disorders • Dyslexia • Voice disorders • Selective mutism Others are acquired during our lives through illness, accident, or, injury, for example, a stroke, neurological degeneration, cancer. Adults • Communication, feeding or swallowing problems and impairments following neurological impairment or degenerative conditions, such as stroke, head injury, Parkinson’s, dementia, neck and throat cancer, or, laryngectomy and • Voice problems • Mental Health issues • Learning Disabilities • Physical Disability • Stammering • Hearing impairment Some can be remedied, or, the symptoms reduced, whilst others may persist and communication aids and augmentative forms of communication are provided if appropriate. Page 7 of 35
To conclude this first part of my talk, you will remember me telling you earlier that there are about 2.5 million people in the UK with some kind of speech disorder, but there will however, also be many millions who develop normal communication without any difficulties. This is amazing as it is one of the most skilled and complicated human achievements. So let’s take a closer look at Human Communication in greater depth. HUMAN COMMUNICATION is a two way process by which information is passed from one person to another - involving a sender and a recipient. In order for Human Communication to be established satisfactorily, three essential criteria have to be met. Three essential criteria to be met: 1. That there is some output from the initiating person 2. That there is some means of transmitting and conveying the information 3. That the recipient can receive, understand and interpret the information Page 8 of 35
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