International journal of language & communication disorders
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Int J Lang Commun Disord · May 2008
Comparative StudyEconomic aspects of a therapy and support service for people with long-term stroke and aphasia.
This paper considers some economic aspects of a therapy and support service for people with stroke and aphasia. This material was part of a broader evaluation of the service, which is reported elsewhere (van der Gaag et al. 2005, van der Gaag and Mowles 2005). ⋯ The economics of speech and language therapy service delivery have received scant attention in the published literature. The paper argues that decision-making about methods of service delivery can be aided by the explicit consideration of the costs and consequences of different programmes.
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Int J Lang Commun Disord · May 2008
Exposed and embedded corrections in aphasia therapy: issues of voice and identity.
Because communication after the onset of aphasia can be fraught with errors, therapist corrections are pervasive in therapy for aphasia. Although corrections are designed to improve the accuracy of communication, some corrections can have social and emotional consequences during interactions. That is, exposure of errors can potentially silence the 'voice' of a speaker by orienting to an utterance as unacceptable. Although corrections can marginalize speakers with aphasia, the practice has not been widely investigated. ⋯ The observation that some instances of exposed corrections effectively silenced the voice or self-expression of the person with aphasia has significant implications for outcomes from aphasia therapy. By focusing on accurate productions versus communicative intents, therapy runs the risk of reducing self-esteem and communicative confidence, as well as reinforcing a sense of 'helplessness' and disempowerment among people with aphasia. The results suggest that clinicians should carefully calibrate the use of exposed and embedded corrections to balance linguistic and psychosocial goals.
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Int J Lang Commun Disord · May 2008
Whose voice is it anyway? Hushing and hearing 'voices' in speech and language therapy interactions with people with chronic schizophrenia.
Some people with schizophrenia are considered to have communication difficulties because of concomitant language impairment and/or because of suppressed or 'unusual' communication skills due to the often-chronic nature and manifestation of the illness process. Conversations with a person with schizophrenia pose many pragmatic challenges as they may include delusional talk or hallucinatory references considered irrelevant or inappropriate to ongoing conversation. Yet delusional talk and references to hallucinations are often an intrinsic part of the overall presentation in people with schizophrenia. The speech and language therapist (SLT) must be aware of the influence and function of these pragmatic challenges in therapeutic interactions with this client group. One way of increasing this awareness in this context is through an exploration of co-constructed 'voices' in speech and language therapy (SLT) interactions. ⋯ The analysis shows that the voice of SLT and the voice of the lived experience of schizophrenia are heard to greater or lesser extents, as determined by the context and content of the talk-in-interaction. However, the voice of SLT must blend with, rather than hush, the plurality of voices that characterise therapeutic interactions. An increased awareness of competing voices, as they struggle to be heard in SLT interactions, may prompt therapists to consider and evaluate their often agenda-driven influence on the unfolding interactions we call 'therapy'.