Approaches
I use a range of approaches to support my clients´ communication difficulties depending on the individual and their specific difficulties, and their goals.
Working with adults
My approach is client-centred, and whilst the treatment approaches are supported by the latest research evidence, therapy will always reflect the individuals´ personal circumstances and goals. After experiencing a stroke, understandably individuals´ motivation in therapy can vary. I see it as part of my role to instil motivation through the therapeutic relationship, celebrating positive changes, and building confidence and hope.
Therapy will address two levels; improving communication between the individual and their family for a better quality of life through compensatory strategies (working around the difficulties), as well as direct therapy to maximise recovery of the individual´s speech and/or language skills.
When working directly to maximise recovery of the individual´s speech and language skills I use a range of approaches, such as Melodic intonation therapy, a musical based therapy to support expressive language in adults with aphasia and apraxia. Having difficulties word finding can be highly frustrating; I work on improving this with approaches such as Semantic Feature Analysis treatment (SFA) and Phonological Components Analysis (PCA) which explore the meaning, or the sounds in the words, to improve the individual´s access to their vocabulary. I will also work with individuals to improve their grammar and length of sentences and phrases with treatments such as Treatment of underlying forms (TUF) and Response Elaboration Training (RET). I use computer based programmes where appropriate as these can be very effective, and motivating for the individual.
I will also help people ´work around´ the difficulties using conversation therapy approaches such as Better Conversations with Aphasia (BCA) programme, and Promoting Aphasics’ Communication Effectiveness (PACE). These aim to improve an individual´s ability and confidence to be an active participant in conversations through compensatory and adaptive strategies, and using multimodal communication (using speaking, drawing, writing, gestures, signs and face expressions). Alongside working with my client, I will dedicate time to working with the people the individual communicates with most often, so that they feel they understand the difficulties and can feel more confident in how to communicate with their loved one.
Poetry can be very beneficial and powerful for adults experiencing communication difficulties so I often use it in some capacity. It challenges speech sound co-ordination, rhythm, rate, breathe control, and prosody (which words we stress). It can be particularly motivating to use for practice material. Also, for adults with aphasia who struggle using and understanding words and sentences, poetry provides a liberating creative access to words. Expressing oneself through poetry can enhance access to other neural pathways, as rhythm and tone are controlled by different parts of the brain than language, and so facilitate verbal expression.
Working with children
I realise that parents are the experts of their own children and are the best `therapists,´ so the majority of my input will be working with parents together in a partnership to support them in helping their child. This is essential for progress with all communication difficulties because the therapy needs to be brought into the everyday environment, not just weekly sessions with myself.
If children are having difficulty using or initiating verbal language I will support the use of alternative and augmentative communication (AAC) to provide an alternative way to express themselves and reduce frustration. AAC may be using pictures, pointing, signs and gestures, and is often, but not always, a bridge to verbal communication. I am trained in using Picture Exchange Communication System (PECS) and Makaton.
I use a play-based and child-led approach with young children and use intervention models such as Attention Autism, which aims to develop attention skills and natural, spontaneous communication through the use of visually based and highly motivating activities. I use Intensive interaction to help children with autism develop early interaction abilities, helping the child connect and relate with others. Sessions often involve the use of music as it keeps children engaged, can have a calming effect, develops listening skills, turn taking skills, and supports their exploration of sounds and self expression. My therapy is supported by principles of applied behavioural analysis (ABA) such as positive reinforcement, pairing, and repetition. It´s also supported by Sensory integration therapy techniques which can be used to help regulate children´s attention, engagement, and emotional stability when learning.
To support children´s understanding of, and the language for their emotions, and how to regulate their emotions I use adapted cognitive behavioural therapy (CBT) techniques which teaches the connection between thoughts, feelings and behaviour, giving them the tools to manage their difficulties. I use The Zones of Regulation, a programme rooted in CBT which raises awareness and increases recognition of emotions, that teaches children about expected and unexpected behaviours (social norms). I also use Social stories to develop children´s social understanding.
I use a range of programmes to support children´s speech sound development and understanding and use of language. Colourful Semantics, a colour coded system, is one programme I use to develop children´s grammar and vocabulary. When working with children with speech sound disorders I use a variety of programmes including The Nuffield Dyspraxia Programme. This is based on a motor skills learning approach, which uses pictorial cues to support children´s production of speech sounds and ability to combine sounds. For some children with speech difficulties, an articulation approach may be used to support their production of specific sounds. For other children, I use a phonological approach, meaning therapy introduces the child to specific and tailored sound contrasts in words which help them `reorganise´ their sound system.