About Blethers

Blethers is a an Independent Speech & Language Therapy Service working in Edinburgh, Lothian and Borders. It was set up by Isla Davies in 2011 and offers a unique mobile speech therapy service providing assessment and treatment for children and young adults who have speech, language and communication difficulties. In addition Isla offer specialist services for people who have Autism, Asperger’s Syndrome and learning difficulties.

Summer in East Lothian!

I thought about writing this post yesterday when summer had indeed arrived in East Lothian, as you can see in this lovely photo of the poppies in a field between Pencaitland and Tranent:

Summer Poppies Pencaitland & TranentSadly it’s a bit cooler and cloudier today but I’m sure there will be more sunny days before the summer is out. Here in East Lothian we are blessed with many beautiful beaches including the especially popular Gullane Bents, Yellowcraigs, North Berwick and Dunbar’s Belhaven Bay.

Panorama of Belhaven By, Dunbar looking North towards North Berwick

Blue skies and clear water at Belhaven Bay, Dunbar

The warm sunny weather brings many families to the beaches and the obvious place to cool off is in that lovely, blue water. However, to the unwary, the water can contain hidden dangers and the conditions are constantly changing with the tide and weather. With that in mind, I would like to point you all in the direction of some helpful advice that should help you stay safe while you’re having a break from your speech and language therapy sessions.

Please click here to go to the RNLI’s Respect the Water page where you will find lots of helpful advice that will help you and your family to enjoy a safe trip to the beach. At the very least:

  • Try to go to a lifeguarded beach if possible. The red and yellow flags you will see there show the safest area to swim in and that part of the shore will be being patrolled by the lifeguards.
  • Remember that swimming in the sea is very different from a pool. The seabed is very uneven and sometimes there are sharp changes in depth.
  • The sea around the UK is very cold, even at the height of summer. Take time to get used to the temperature as you go in and if you have a wetsuit, wear it. The Respect the Water website has some great advice about what to do if you fall into very cold water suddenly.
  • Make sure someone on the beach is keeping an eye open for you and can call for help if necessary.
  • Understand what a rip current is and what to do if you find yourself in one. Click here to watch Gwithian Academy of Surfing’s excellent video explaining rip currents. Basically a rip is a current that forms where the water coming into the beach in the waves flows back out to sea. They pull out to sea and may stay in one place like when they form around rocks or they can move around the beach as the tide changes. If you find yourself in a rip, swim at right angles to it (usually parallel to the beach) until you are free from its pull then either try to get attention and/or swim back into the beach. NEVER try to swim directly against a rip current, you will exhaust yourself and then you will be in a lot of trouble.

If you see someone in trouble in the water, your first action should always be to dial 999 and ask for the Coastguard. The Coastguard will then come to your assistance and will alert the RNLI lifeboat teams if necessary. If you can, avoid going into the water yourself as many people drown trying to save others.

Stay safe on the beach this summer and have fun!

Isla enjoying a sunny, windy day at Longniddry

Isla enjoying a sunny, windy day at Longniddry


Understanding Language Comprehension

As a speech and language therapist, I often have children referred to me because their language is late to develop. Whilst those who know the child may feel that the main issue is lack of spoken words and may say he/she ‘understands everything’, it often becomes apparent during assessment that things are not what they seem. Children are great little detectives! In day to day life, they are constantly scanning their environment for clues that will help them understand. It is possible for a child to understand an instruction like ‘Go and put your coat and shoes on then wait by the front door’ without understanding a single, solitary word! But how? The answer is ‘Situational Understanding‘.

What is Situational Understanding?

From a very early age, we start to make links between things that happen around and to us, starting with cause and effect. Babies quickly learn that crying (cause) usually results in comfort of some kind (effect – often food or cuddles). As we grow and learn, we start to associate related things and we use this information to make sense of the world. Often, before children can speak much at all, they will do things like go to the table when you open the fridge or the cupboard where the snacks are. This is situational understanding – the child has learned that when you open the fridge or cupboard, the next thing that usually happens is that they get a snack at the table. The child does not need to understand any words to react appropriately, they are using the information from the situation to understand. Situational understanding is an essential skill that we all use throughout our lives. Ever been to a party which features folk dancing you’re not familiar with? Usually we watch what other people do and copy – we use what we see in the situation to understand what to do. That is what situational understanding means.

Let’s think now about our instruction ‘Go and put your coat and shoes on then wait by the door’. Your child will most likely have noticed that when you put your coat on and get the buggy ready, the things that follow are that you put their coat and shoes on then go out through the door. If you deliver the instruction while you are standing in the hall with your coat on and getting the buggy sorted out, your child doesn’t need to process any of the words you have said, they can follow it simply by using their knowledge of the situation they see.

To assess and work on true understanding of language, you need to consider how many words in the sentence the child HAS to understand in order to follow it, these are usually called either Information Carrying Words (ICWs) or Key Words. That means taking into account the environment, the situational information available and the choice of related objects on offer. It sounds mind-bending, but once you get into the swing of it, it’s fine!

What is an Information Carrying Word or ICW?

Quite simply, it’s a word (or short phrase) that gives you the information you need to follow an instruction without any situational clues. Let’s take the instruction ‘Go and put your coat and shoes on then wait by the front door’ and alter the situation to make some of the words carry essential information, i.e. turn them into Information Carrying Words.

First of all, the instruction needs to be given BEFORE you, yourself start getting ready and while you are away from the door. Secondly, words that have a grammar function don’t count when it comes to information carrying words! So we can get rid of a few words straight off: ‘Go and put your coat and shoes on then wait by the front door‘. Now we have 4 candidates to become ICWs! In the examples below, I’ve highlighted the ICWs in red and the things the adult does to support understanding of the additional words in blue.

1 ICW – ‘Go and put your coat (give the child the coat) and shoes on then wait by the front door (point to the door)‘. Here the child has to understand the phrase ‘shoes on‘ to follow the instruction. The situational prompt of being given the coat should be enough to prompt putting it on and pointing at the front door will prompt the child to go there. We’re going to assume that waiting is what the child usually does at the door, so there’s no new information in that word either.

2ICWs – ‘Go and put your coat and shoes on then wait by the front door (point to the door)‘. Here the child needs to understand both ‘coat‘ and ‘shoes on‘ but the point gives a clue as to where to go.

3 ICWs – ‘Go and put your coat and shoes on then wait by the front door‘. This time, you haven’t pointed to the front door so, not only does the child need to understand which items to get but also ‘front door‘ (as opposed to back door) so that they go to the right place.

I hope this isn’t too confusing! The easiest way I find of sorting out how many ICWs I’m giving a child is to think ‘is there a choice for each word in this instruction?’.

Here are some toys that I might use to work on developing understanding Information Carrying Words

Here are some toys that I might use to work on developing understanding Information Carrying Words

If I give the child the items in the picture plus the instruction ‘make Igglepiggle jump on the bed‘, I can be confident that it is a 3 ICW instruction because of the following choices:

  1. Igglepiggle or Upsydaisy
  2. Jump or any other action
  3. Bed, table or chair

Your speech and language therapist will help you to ascertain how many ICWs your child can understand at a time and will help you see if there are any patterns within each level of understanding. For example, a child may understand 2 ICW instructions made up of a person plus an object (eg ‘Give Igglepiggle the chair’) but not ones made up of a person plus an action (eg ‘Make Upsydaisy sleep‘). Usually speech and language therapists will work in 4 levels with ICWs – 1, 2, 3, and 4 ICWs in a single instruction. Beyond 4ICWs, things start to get more complex!

Bridging Between Levels

Once your child consistently understands a variety of instructions at the level you are working on, your SLT will advise you on how to ‘bridge’ to the next level. That usually involves using real objects, visual aids like pictures, sign language and/or pointing to give your child a clue about the extra ICW you have added. For example, if you are wanting to help your child get from 2ICWs to 3 using the materials in the picture, you might do the following to support understanding of ‘make Igglepiggle jump on the bed’:

  • Give the child Igglepiggle first
  • Sign ‘jump’ as you say it
  • Give the child the symbol for ‘jump’ as you say it
  • Point to the bed

The choice of materials is still there because you’d use all of the objects to maintain the choice for each ICW but you are making it a little easier by helping the child with one of the choices.

I hope that this article goes some way towards demystifying the concept of Information Carrying Words or ICWs ! Please leave me any comments or questions and I will do my best to answer them!

A Beginners Guide To Grammatical Terms

User Friendly Dictionary of Grammar

My well-loved copy of TUFDOG

If you are either a parent of a child who has a language disorder or you’re planning to train as a speech & language therapist in the future, then this post is for you! When I went to my very first Linguistics lecture way back in October 1992 the lecturer, one Professor Jim Hurford (you’ll find his biog here if you are interested!), handed us all a bundle of paper which he dubbed ‘The User Friendly Dictionary of Grammar’ or ‘TUFDOG’. This document contained definitions of pretty much every grammatical term you could think of from ‘noun’ to ‘relative clause’. Prof Hurford’s reasoning was that, since schools had moved away from teaching the meanings of such terms and a clear understanding of such vocabulary is essential for students of linguistics, he’d best make sure we all knew our adverbs from our adjectives. Over my 4 Years studying Linguistics at Edinburgh, TUFDOG was invaluable and, as you can see, I still have my well-thumbed copy!

I am happy to tell you that TUFDOG was formally published in 1994 in much flashier format as ‘Grammar: A Student’s Guide‘ and it is still available from Amazon!

Anyway, getting to the point of this post, it occurs to me that if you are not someone who uses grammatical terms on a daily basis (so pretty much the whole world except for SLTs, language teachers, journalists, writers and editors) then I thought it might be helpful to have a brief explanation of the basics. This will be particularly useful if you are the parent of a child who has a language disorder as you will most likely be asked to work on one or more of these areas with your child.

Noun – a noun is the name of something. ‘Common nouns’ are the names of objects like ‘ball’, ‘sock’ or ‘house’. A good way to check if something is a common noun is to see if it makes sense if you put ‘the’ before it. For example ‘the house’ makes sense but ‘the drinking’ feels like it’s not finished and ‘the beside’ just plain doesn’t make sense! The names of people and places are also nouns but form a subgroup called ‘proper nouns’. Proper nouns don’t make sense with ‘the’ and typically have a capital first letter; eg ‘Isla’, ‘Edinburgh’, ‘Scotland’

Pronoun – a pronoun is a short word that you can use to replace a noun in a sentence so that you don’t end up repeating yourself all the time.

By way of example, you could say the following: ‘I saw James at the park yesterday. James said James was at the park to meet Polly. James and Polly were planning to go for ice cream together. Polly loves ice cream, Polly says ice cream’s Polly’s favourite food’ however, that sounds a bit repetitive with all the ‘Jameses’ and ‘Pollys’. Most people would probably use some pronouns to make it sound a bit better ‘I saw James at the park yesterday. He said he was at the park to meet Polly. They were planning to go for ice cream together. Polly loves ice cream, she says it‘s her favourite food’.

As you can see, we have different genders of pronoun: male, female, gender neutral as well as plural pronouns. There are also variations on each of these depending on where they come in a sentence. This can be really confusing for children who have a language disorder and they generally try to simplify the system by using only one gender and typically only one variant. In my experience, it is typically the male pronouns a child like this will stick to and if there is only one variant used, it will be either ‘he’ or ‘him’ (eg ‘him is washing him hands’). In English our pronouns are:

A list of English pronounsAdjective – quite simply, an adjective is a word that describes a noun. Some examples of adjectives are colours, sizes like ‘big’ or ‘enormous’ and attributes like ‘nice’, ‘long’ or ‘soft’. If you’re not sure if a word is an adjective, try it with a noun and see if it works; ‘the chair is soft’ works but ‘the chair is in’ sounds unfinished and ‘the chair is quietly’ doesn’t make sense.

Verb – ‘verb’ is another word for ‘action’, it is something you do. Examples of verbs are ‘love’, ‘run’, and ‘eat’. Verbs form the core of a sentence and they dictate what roles (see below) or positions need to be filled to finish that sentence so that it makes sense. For example ‘give’ is a verb. To use ‘give’ in a sentence we first need to have someone to do the giving but ‘Sue is giving’ isn’t a complete sentence. So give also needs something to be given but ‘Sue is giving the cake’ still isn’t a complete sentence. It turns out that ‘give’ also requires someone to receive whatever has been given so our complete sentence is ‘Sue is giving the cake to Bob’. By way of contrast, the verb ‘sleep’ needs only someone to do the sleeping to make a complete sentence ‘The dog is sleeping’ , you can add other things but these are optional. This is why it is so important for children to learn verbs as well as nouns as part of their early vocabulary. Without verbs, it is impossible to build grammatically correct sentences.

Roles – ‘Roles’ are the slots in a sentence that need to be filled to make the sentence complete. As described above, the verb you use dictates which roles need to be filled. The main roles to be aware of are ‘Subject‘, ‘Object‘ and ‘Indirect Object‘. There are others but you only need to know about those if you are studying in detail! The subject is the ‘doer’ of the action and in English, all verbs require at least a subject to make a complete sentence – The boy is drinking. The object is whatever the action is done to and many verbs require an object as well as a subject – The boy is drinking juice. You will also come across indirect objects which are typically the beneficiary of the action – The boy bought some juice for his brother. In English, the order of these roles in a sentence is usually subject, verb, object, (indirect object) or SVO(Oi).

Tenses – verbs in English have different endings and sometimes other words used with them to show when the action happens in time. Examples are:

  • James has tidied his room or James tidied his room – past
  • James is tidying his room or James tidies his room – present
  • James will tidy his room or James is going to tidy his room – future

There are many distinctions of different types of past, present and future tense but discussion of those in detail here will just get confusing! For the purposes of early language development, the most important thing is to ensure a child is able to express the basic 3-way past/present/future distinction.

Adverb – An adverb is a describing word much like an adjective but it describes a verb rather than a noun. Adverbs describe how something is done and very often end in ‘-ly’, examples are: gently, quickly, carefully. You can often turn an adjective into an adverb by adding ‘-ly’ to the end. For example in the sentence ‘Your dress is nice’, the word ‘nice’ is an adjective which describes the dress. On the other hand, in the sentence ‘Your dress is nicely made’, the word ‘nicely’ is an adverb which describes how the dress has been made, ‘made’ being the past tense of the verb ‘make’.

Preposition – a preposition is a word that tells you about a location or position. Examples are: in, on under, between, behind, in front. Many children who have language delays or disorders need some help to learn these. Prepositions are essential for daily understanding and are also fundamental building blocks for sentences.

Plural – a plural simply means ‘more than one’. Typically in English, we put a ‘s’ on the end of a word to show there is more than one, this is called a ‘regular plural’ because it is a regular pattern. Examples of regular plurals are ‘houses’, ‘socks’, ‘plants’. In English there are a subgroup of plurals which don’t follow this pattern and these are called ‘irregular plurals’. Examples of irregular plurals are ‘mice’, ‘geese’ and ‘sheep’.

That just about covers the main ‘parts of speech‘ that you are likely to come across if you are working with a speech and language therapist. Incidentally the term ‘part of speech‘ is a term that means a group of words which share the same characteristics in language. Basically, parts of speech are the building blocks you need to make sentences. Nouns, verbs, adjectives, pronouns, prepositions, adjectives and adverbs are all parts of speech. It’s important to keep parts of speech in mind when you are working with a child who has language problems, particularly if they do not speak in sentences. In order to build sentences, it’s essential for a child to have a variety of words from various parts of speech in their vocabulary. A mix of nouns, verbs, adjective, adverbs and prepositions makes many more combinations available than just nouns and adjectives.

I hope that this article is useful and please do leave me a comment if you’d like further explanation or you’d like me to add something which I haven’t included!

Language Building Apps for iPads and Tablets

Arguably slow on the uptake, I have just discovered the Splingo group of apps from the Speech & Language Store. I’m glad I found some time to look into Splingo as the apps have already been a big hit with several of my clients!

Designed by speech & language therapists, Splingo is a set of apps aimed at teaching children at developmental levels of around 18 months – 4 years the following core language skills:

Splingo’s Language Universe – Understanding instructions with 1, 2, 3 and 4 Information Carrying Words (post explaining ICWs coming soon…) plus listening and attention. This App also targets understanding and using different types of word – nouns, adjectives, prepositions and so on.

Actions with Splingo – Understanding and use of action words (verbs).

Pronouns with Splingo – Understanding and using pronouns like she, I, them, we and so on.

Categorisation with Splingo – Categorisation of vocabulary and building links between word meanings.

Screenshot from Categorisation With Splingo app by Speech & Language Store

Screenshot from Categorisation With Splingo

As the adult, you can set up the apps at the appropriate level of complexity for your child, you can even choose between an American or British voice. I love that last feature as so many language apps are very Americanised!

Each app sets up a series of instructions based on the areas you have specified (for example, using and understanding the pronoun ‘she’) and your child works through the activities in a game format with integrated rewards. The animations and characters are attractive, fun and motivating for children.

Screenshot from Pronouns With Splingo app by Speech & Language Store

Screenshot from Pronouns With Splingo

The learning apps are available for anyone to use, although it’s probably worth getting some advice from a speech & language therapist or teacher first, especially if your child has any sort of additional needs. If you are reading this as a speech and language therapist, I should point out that there is also a Splingo Receptive Language Assessment App which is available for use by SLTs. So far, I have found this extremely useful, particularly for clients who have limited attention for picture-based activities and especially those who are unable to accept enough direction in their play to be assessed with toys.

At the time of writing, all Splingo Apps are available from the iTunes App Store and you can find Splingo’s Language Universe and Pronouns with Splingo on Google Play. Of course, if you would like some advice on using any of the Splingo Apps with your child, feel free to contact Isla at Blethers, email is usually the best way to catch me: blethersslt@gmail.com

Remember, you can find out more about Splingo from the creators, Speech & Language Store!

Pre-Literacy Skills for School Starters

In a few short weeks, thousands of 5 year olds will be starting in P1 at school. Central to success at school and in later life is learning to read and write. Did you know that the key skills for successful literacy development are built on our speech processing skills?

Photo of popular childrens' books , Zog, Bear Hunt and Dinosaurs Love Underpants

Some popular children’s books used in schools across the UK

Most young pre-school children are aware of words as whole chunks and that words help them communicate with others, however, they are not typically aware that each word is made up of smaller bits like syllables and individual speech sounds. As they approach school age, they start to become more aware that there are divisions within words and might start to experiment with syllables and rhyming (word endings). These broad divisions are the beginnings of phonological awareness for literacy.

Our spelling system in English is ‘alphabetic’ which means that there is a letter or sometimes a group of 2 letters like ‘sh’ that corresponds to each spoken sound. To be able to match sounds to letters for literacy, children need to be able to divide words up into individual parts, a bit like taking apart a jigsaw to see how many pieces there are. Because the first sound in a word is emphasised by virtue of being the first one you hear, children typically learn the concept of ‘begins with’ as the first step in this process. They then go on to break the word down further and start to realise that there are sounds at the end and in the middle too. It is easier for children to pick sounds out of a word if it is said on its own rather than in a sentence. There is now a lot of research which shows that well developed phonological awareness is linked strongly to later success in learning to read and write.

So, what skills does phonological awareness involve? Well, for typically developing pre-schoolers about to go into P1 or reception class, the following are core skills:

  • Attention & listening – it may seem obvious, but before we can do any form of learning at all, we need to be able to pay attention to what we hear! Related to this is the ability to listen to spoken information and to discriminate between sounds that are the same or different from one another.
  • Auditory memory – before we can start to break what we hear into smaller chunks, we must have enough capacity in our short term memory to hold onto what we’ve heard while our brains process it. Most 4 year olds will be able to remember a spoken instruction with up to 4 key parts. If you would like to look at auditory memory/attention/listening averages in more details, click HERE to go to Ellen A. Rhodes’ Auditory Developmental Scale: 0-6 Years.
  • Segmentation – when we are talking about spoken language, segmentation means breaking long strings of spoken language into smaller parts. Unlike written language, spoken language does not typically have nice, clear spaces between words. The first thing we need to do as language learners is to be able to break the speech stream into separate words. Once we have established where the word boundaries are (most typically developing children can do this well before starting school), we can start to break words into smaller parts like syllables, onset/rime and individual speech sounds.
  • Speech sound discrimination – in order to match a sound to a letter, you need to be able to hear it and know which sound it is. Some of the speech sounds used in English are clearly acoustically distinct from one another, like ‘s’ and ‘m’ or ‘k’ and ‘b’. Others are much harder to distinguish between on the basis of sound alone like ‘m’ and ‘n’, ‘s’ and ‘f’ or ‘d’ and ‘g’. Obviously, you need to know which sound you are hearing to be able to match it to the appropriate letter and therefore read and spell correctly.
  • Sound Sequencing & Manipulation – In order to read and spell, we need to know what sound a word begins with as well as which sounds follow and in what order. Another essential skill is the ability to manipulate sounds and sections of words to do things like swap a sound to make a new word (eg swapping vowels to give foot, fat, fit, fight and so on) or swap the first sound or syllable to make a rhyme, for example, if we take ‘f’ away from ‘fight’ to leave ‘ight’, we can add ‘l’, ‘n’, and ‘r’ to make rhyming words ‘light’, ‘night’ and ‘right’. Knowing ‘tricks’ like swapping initial sounds like this helps us to be more efficient in our reading and spelling.

This is by no means a definitive list of phonological awareness skills, however these are the core skills that children rely on when learning to read and write. If you are concerned that your child is not developing these skills and their speech is still difficult to understand at 4-5, then I would recommend requesting an assessment by a speech and language therapist so that any problem areas can be identified and addressed.

If you are happy that your child’s speech is developing well but you’d like to give him/her and extra boost with those pre-literacy skills, check out Top Tips for Early Phonological Awareness & Pre-literacy Skills on my website for some simple and practical ideas.

Special Needs Friendly Summer!

As the summer holidays are upon us, I thought I would make you aware of a couple of special needs friendly summer activities that are on offer in East Lothian and Edinburgh. Please feel free to send me a comment or a Facebook message if you know of anything else I should include! This is by no means a definitive list!

  • Odeon Cinemas offer monthly autism-friendly screenings for children, you can find the schedule on the Odeon website – CLICK HERE
  • If you have a family member who is a wheelchair user, did you know you can access the beautiful beach in North Berwick with a special beach wheelchair loaned free of charge from North Berwick Beach Wheelchairs? You will find them at the Beach Hut on North Berwick Harbour, just behind the Scottish Seabird Centre or CLICK HERE to visit the website.
  • Sticking with the beach theme, Coast 2 Coast Surf School welcome special needs groups to their surf school. What a great opportunity to get your kids accessing the sea safely! CLICK HERE to visit the website.
  • The Scottish Seabird Centre also welcomes children with special needs of all kinds and provides an interesting day out for children and adults alike. CLICK HERE to visit the website.
  • If animals are your child’s thing then a visit to East Links Farm Park is always good fun, CLICK HERE to visit the website for more information.

Have fun and stay safe!

Summer Sunset North Berwick, East Lothian


Making Speech & Language Activities Easier or Harder

I was asked recently about how to make activities easier or harder for clients. When you’re training to be an SLT or indeed working as a newly qualified SLT, this can be one of the hardest parts of the job as you often have to make adjustments on the spot. With experience this gets easier but even the most seasoned SLT will have moments where they realise a re-think is required. The bottom line is, there is no magic list of incremental steps, knowing how to step therapy activities up and down is the very essence of the specialist skills that we learn when we become SLTs. That’s what all that theory is for and one of the reasons why “Speech & Language Therapist” is a protected professional title! Having said that, understanding a few key points is helpful when doing your planning especially while you are training or in your probationary year.

Before we continue…

First and foremost, 2 important things to remember are:

  1. If a task is clearly way too hard for a child, you can just stop doing it! Better to stop and do something easier than to continue with something that sends a message of failure. If you have no easier therapy task, there is nothing wrong with just playing a game together to regain the child’s trust and build rapport.
  2. There is absolutely nothing wrong with throwing an easy task into a therapy session. It gives the child experience of success and helps them feel comfortable. So if you do find yourself with too easy a task and no way to step it up, don’t panic!

The importance of thorough and ongoing assessment

To my mind, the most important part of being able to step activities up or down for a client is to have a very clear understanding of what their individual strengths and weaknesses are. That is why doing a detailed and comprehensive assessment is always my first port of call with any client. If that takes 2 or 3 or even 4 sessions, then so be it! Therapy will always be more effective when it is based on a clear set of assessment findings.

Of course, no assessment is foolproof and an assessment only gives you a snapshot of the child’s skills on a particular day. With that in mind, constant observation of the child during therapy sessions is also essential. Their strengths and weaknesses may vary depending on external factors like the amount of sleep they had last night, the time of day, whether they’re coming down with something, perhaps they’re excited about an upcoming event and so forth. You may find that they may learn the new skill you are teaching either more quickly or slowly than you anticipated and you need to account for this too.

Planning Therapy

Obviously it best practice to plan your therapy ahead but I would advise against over-planning. By ‘over-planning’, I mean doing something like sitting down and writing a detailed plan of exactly what you are going to do in each session of a 6 week block. By all means, have an overall outline plan for the 6 weeks based on your assessment and therapy aims but I’d advise adding specifics into your individual session plans no more than one or maybe 2 sessions ahead. That means that you have your overall ‘map’ of what you are doing in the block to keep your therapy focused but you have the flexibility to alter your weekly plans session to session based on the child’s performance each time. Here’s an example of a plan that I have actually used from the start of a 6-week block.

Example Speech & Language Therapy Plan

One of my pre-block plans. As you can see, I have only done specific plans for sessions 1 & 2 of the block at this point.

Something I have not shown here is how to step up or down these activities. That’s because I know this child really well and have various tricks up my sleeve based on my previous experience as an SLT and with this child in particular. And here’s the rub! As I said at the start, I cannot give a definitive list of what to do to make things easier or harder for clients because that list will be different and individual for each child. However, I can share the key things I take into consideration when planning and working out how to step activities up or down. These are:

  1. What CAN the child do? Are there stronger areas of their language/speech processing that we can use to support weaker areas?
  2. What is the child likely to find more difficult but still achievable?
  3. What scaffolds can I use to support learning of more difficult skills? (Modelling, visual supports, signing and so on) How will I fade out the use of these scaffolds?
  4. What things are going to be outside of the child’s current skill set developmentally?
  5. What things are going to be outside of the child’s skill set based on their disorder?
  6. Given each activity I have planned for the next session, how can I make each activity one step easier or harder based on what I know of the child and the answers to questions 1-5?

Obviously keeping accurate notes of your sessions comes into its own here because you can then use the information you recorded to see how the child did, which supports worked and which supports you can try fading out next session.

I hope that this is helpful for those of you having trouble with stepping up and down. You are not alone! If you have questions about specific clients, do feel free to email me at blethersslt@gmail.com I will get back to you as soon as I can but do bear in mind it can take a couple of weeks!


A Day In the Life of a Speech & Language Therapist

A Typical Day as a Speech & Language Therapist

I was asked recently to describe a typical day working as a Speech & Language Therapist. A simple question, right? WRONG! After quite some deliberation and a few false starts, I had a dawning realisation. I was struggling to describe a typical day as an SLT because THERE IS NO SUCH THING! In fact, the unpredictability and variation is exactly why I enjoy being a speech and language therapist. I can say with complete honesty, I have never, in 14 years as a speech and language therapist, been bored at work. How many people can say that, hand on heart? At work I have been amazed, stressed, amused, overwhelmed, challenged, excited, sad, worried, fascinated…. and the list goes on, but never, ever bored. It’s a bit of an emotional rollercoaster this speech & language therapy lark!

Why is Speech & Language Therapy so Varied?

There are several reasons why it is difficult to be bored at work if you are a speech and language therapist. First and foremost for me, is the beautiful diversity of people. Now, as a paediatric SLT, I can only really comment on children but I’m sure my colleagues in adult services will agree the following observation: Genuinely and without exception, every client is different. As we train to be SLTs we learn about groups of clients like “neurotypical children”, “children with autism” or “late talkers”. There’s nothing wrong with this, it helps us to learn, but when you actually get out there and meet a few clients who share a diagnosis, it immediately becomes obvious that NO TWO ARE THE SAME! This is all part of the fun! Meeting a new client for the first time, figuring out what motivates them, building a rapport, problem-solving their communication difficulties, watching them progress is the whole point of what we SLTs do and it is endlessly interesting.

Then there is the fact that most speech and language therapy jobs involve working in at least 2 different locations throughout the week. We SLTs can be found in health centres, clinics, hospitals, schools, nurseries, clients’ homes, specialist schools/units, private clinics and even prisons (working, not generally detained at Her Majesty’s Pleasure!). Obviously each separate workplace involves a different set of challenges, colleagues and clients.

As well as the range of clients and working environments, and SLT must also make use of a huge variety of skills and roles. In addition to the ‘therapist’ role you signed up for, you often find yourself wearing any combination of heads including, but not exclusively, some of the following:

  • trouble-shooter – The usual strategies aren’t working for this particular child (they’re all different remember!), why is that and what are you going to do next?
  • artist – No-one else is going to make the reward chart you need to help your clients stay focused in that social skills group next week…
  • counsellor – You have a distraught parent in your treatment room because their child has just been diagnosed with autism…
  • logistics manager – Exactly how are you going to drive between 4 home visits and still be back to your clinic in time to write up all the case notes? What’s the most time-efficient route? Where will you park?
  • child – Yes, if you’re going to build a relationship and get the best out of a child, you need to be able to play like one!
  • sneaky sabotager – How are you going to get wee Johnny to ask for that toy car using his voice? You know he can say it but he doesn’t realise that the word gets him a go of his favourite toy. Yes, you’re going to sabotage his favourite car-run game by giving him the track but no cars!
  • writer and author – so you know what ‘Phonological Awareness’ means, how are you going to explain clearly what it is in a report for a parent with no prior knowledge of linguistics? And furthermore, who else is going to write you a story crammed full of words beginning with ‘s’ for little Julie’s session tomorrow?
  • researcher – a child with a diagnosis of Angelman Syndrome has just landed in your clinic room. What on earth is that?
Cleaning the carpet in the Mobile Therapy Room

Typical day in the life of a speech therapist? Working for yourself means you have to do EVERYTHING!

As a speech & language therapist, you will find yourself in all sorts of roles and, to be fair, any good SLT training course will have prepared you (at least in part!) to take on the many faces of an SLT. If you are considering applying for SLT training, it’s important to be aware that you will have very varied roles to fulfil and to appreciate that you will need to be very flexible in your thinking at all times.

So there you have it. There is no ‘typical’ day in the life of a speech and language therapist and that is exactly why it is such a great vocation to have! You can find out more about training to be a speech and language therapist from the Royal College of Speech and Language Therapists.


Donate your Voice!

Donating your voice to help Motor Neurone Disease sufferers

Did you know that you can ‘donate’ your voice for the benefit of adults who suffer from Motor Neurone Disease? The Voicebank Project has been set up by the University of Edinburgh in conjunction with the Euan MacDonald Centre for Motor Neurone Disease Research. This research project aims to create a library of voices that can be used to ‘reconstruct’ patients’ natural speaking voices, including accent, for voice output communication aids.

Why is the Voicebank Project necessary?

Perhaps the most famous voice output communication aid (or ‘VOCA’) user and MND sufferer alive today is Professor Stephen Hawking. I think most of the modern world is familiar with the very synthetic and unnatural voice that his VOCA, The Machine, produces. Whilst professor Hawking’s device has been upgraded over the years, it seems that he has come to see the synthetic voice it produces as his own and has refused an upgrade to more natural sounding speech. In fact, I believe he has even copyrighted his synthetic voice, that means if you hear his voice on anything from The Simpsons to Big Bang Theory, yes, it really is him! You can find out more about Professor Hawking’s voice and The Machine on Professor Hawking’s website if you are interested.

Although Professor Hawking has come to accept his synthetic voice, the vast majority of people are devastated by the prospect of losing their natural speaking voice and having to replace it with something so robotic. Being diagnosed with MND or another neuro-degenerative disease is devastating enough without the indignity of having to ‘speak’ with a voice that you don’t feel belongs to you. After all, as I have described in a previous post right here on this website, Your Voice is your Auditory Face.

This is where the Voicebank Project comes in. The aim is to create a database of natural male & female voices with a variety of regional accents which can be used in conjunction with recordings of the patient’s own voice and those of their close relatives so that  VOCA users can choose a voice for their communication aid that they are comfortable with and that they feel reflects their own identity. You may wonder why the patient’s own voice can’t simply be recorded and used in the VOCA. Well, the fact is that for many people, one of the first noticeable symptoms of a neurological condition is in fact changes to their speech. By the time they are diagnosed, the patient’s speech is often significantly affected which is why a degree is of voice reconstruction is usually necessary. Do be aware though that at this stage, Voicebank is a research project only and not a fully-fledged and widely available service. Hopefully it will become part of the standard service for all VOCA users before too long!

I’m interested! What do I do now?

If you are interested and are over 16, have no reading or speaking difficulties and are a first language speaker of English, email info@smart-mnd.org to find out how to donate your voice. In particular, the project is needing male speakers from all over Scotland and from the areas shown on the leaflet here:

Leaflet from Voicebank giving details of accents requiredRecordings take about one hour and are done either at the New Royal Infirmary in Edinburgh or via the mobile recording team (Scotland only). You will need to wear a set of headphones and a little microphone and you will be asked to read a selection of sentences from a computer screen. Don’t worry, the text is big and easy to read! I recommend bringing a bottle of water as you’ll get a dry throat from all that talking. Go! Donate your voice!

If you would like to find out more about Motor Neurone Disease, visit the UK’s MND Association.

Blethers Meets the Tall Ship in Leith

I was quite amazed when I turned the corner at Ocean Terminal in Leith and was confronted with the sight of the majestic ARC Gloria tall ship staring back at me. I’m sure you will agree that she is an impressive ship and her Colombian flag is particularly huge! I believe she is owned by the Colombian military and is in town for the Tattoo. I recommend popping down to Leith for a look, she’s a pretty impressive beastie. The Scotsman have published a wee report if you want to find out more, click here.

Tall ship, ARC Gloria in Leith docks with a REALLY BIG Colombian flag

ARC Gloria in Leith docks with a REALLY BIG flag.