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COMMUNICATING QUALITY 3 (RCSLT, 2006) STATES THAT SPEECH AND LANGUAGE THERAPY INTERVENTION IS LIKELY TO INCLUDE WORK TO ENSURE THAT COMMUNICATIONDISORDERS DO NOT PRECLUDE OPPORTUNITIES FOR SELF-DETERMINATION, FULFILMENT AND PARTICIPATION IN COMMUNITY LIFE (p. 100). OUR TWO CONTRIBUTIONS SHOW HOW SERVICES CAN MOVE INTO COMMUNITY VENUES AND OFFER FLEXIBLE PROGRAMMES THAT INCREASE OPPORTUNITIES FOR PEOPLE WITH COMMUNICATION DIFFICULTIES TO PARTICIPATE IN NEW ACTIVITIES AND LEARNING.
Reference RCSLT (2006) Communicating Quality 3. London: Royal College of Speech & Language Therapists.

HOW I (1): ADULT ACQUIRED

Windows of opportunity
FOR PEOPLE WHO HAVE NOT GROWN UP WITH WINDOWS OR WORD, FINDING THEIR WAY AROUND A COMPUTER CAN BE A TRIAL AND THIS IS COMPOUNDED IF THEY HAVE COMMUNICATION DIFFICULTIES. VICKY STYLES, SARAH WOODWARD AND ALEX DAVIES EXPLAIN WHY AND HOW THEY SET UP AN INTENSIVE GROUP IN A COMMUNITY SETTING TO ENSURE THEIR CLIENTS COULD MAKE THE MOST OF THE OPPORTUNITIES OFFERED BY COMPUTER LITERACY.

INTO THE COMMUNITY (1) ADULT ACQUIRED WINDOWS OF OPPORTUNITY INTO THE COMMUNITY (2) ADULT LEARNING DISABILITY liveACTIVE

ur Computer Assessment and Training Service (CATS) was established five years ago. It provides assessment, support and advice to clients and healthcare professionals living in the southwest region and beyond. The service offered covers computer access and software options (for therapy, skill building and recreational purposes) for individuals with communication difficulties. Over the years, it has become apparent from work with local clients that assessment and advice are not always enough, and that they often require assistance above and beyond the remit of our service. For a lot of the clients we see, finding appropriate software and hardware solutions is the tip of the iceberg. In addition, they need help to find their way around their computers, to open and shut down documents, create and save documents, navigate through pop-up menus and generally build their confidence in operating a personal computer (PC). For some of them, seeing us in the assessment centre is the first time they have ever used a computer. A few hours input from us is not enough and their local speech and language therapist cannot justify spending their dedicated speech and language therapy sessions undertaking this kind of work. A number of our clients have investigated accessing free information technology courses provided through local libraries and further education colleges. However, these courses are often inaccessible for people with communication difficulties, as the style of delivery and materials used are not aphasia-friendly. Our clients described problems with the language used by the tutors, and the rate at which they run through topics. It quickly became apparent that a group would be a good way for us to target a larger number of people with similar needs who did not have a background of using computers. In the past, the service had offered consecutive weekly computer groups. Each session lasted two hours and ran once a week for 10 weeks. However, the feedback from group members showed that they had found it difficult to retain the newly learnt information from one session to the next. We therefore decided to devise and trial an intensive group course targeting basic computer skills. Group members were recruited via local speech and language therapists. In total there were five members, four of whom had aphasia and one who had Parkinsons

READ THIS IF YOUR CLIENTS WANT TO LEARN TO USE COMPUTERS LOCAL COURSES ARE NOT SUFFICIENTLY ACCESSIBLE YOU HAVE LIMITED TIME TO OFFER THE SUPPORT NEEDED Disease. We had planned to run a group for no more than six participants due to staffing levels and equipment resources. A pre-requisite for inclusion on the course was that each group member had to have their own computer at home so they could consolidate skills learnt.

Orientation
We started with an informal orientation session designed for members to get to know one another, so that introductions did not eat into group time. Each group member was asked to bring photographs or information about their interests and hobbies which could be shared with the rest of the group. This information was used to tailor activities and tasks to include each individuals particular interests, for example copying and pasting photographs of favourite football teams; opening and closing documents about popular rock bands. Although this involved a lot of extra preparatory work, including finding additional materials from the internet and saving them onto disk, the clients definitely appreciated it and so their motivation increased. Once the exercises were produced, these were saved to disk so that the clients could complete their homework tasks. During the orientation session, each group member completed a pre-course pictorial rating scale describing their current computer skills (figure 1). The results of this survey revealed that all members found basic computer operations confusing. We arranged five practical sessions on Monday, Tuesday, Wednesday, Friday and Monday at the local community hospital. Group members were asked to complete tasks during their Thursday rest day, aimed at revising the content of the course so far. Each session ran for two hours in the morning. Each group member had a laptop to work on. We originally planned to run the course via a PowerPoint projector, so that group members could copy the screen step-bystep. After a couple of attempts, we abandoned this method because the majority of group members found it too difficult to shift their attention from the projected image to

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TO THE COMMUNITY
their own computer. Thereafter, each session started with an introductory talk and then group members continued with their own tasks individually. The members would ask for assistance when they needed help. The group therefore ended up being much more like an individual training session with more than one client present.

Aphasia-friendly
Each group member was provided with an aphasiafriendly folder of instructions at the beginning of the course. These handouts were designed around the research findings of Cottrell and Davies (2004) on how to produce aphasia-friendly resources: 1. A small amount of information appeared on each screen. 2. Font size 18 was used throughout the document. 3. Pictures were used wherever possible, for example left click was presented as:

4. Screen shots were used each step of the way, to allow members to compare how the operations looked on screen. The handouts were referred to throughout the sessions. Group members worked independently on the tasks during the sessions, and were encouraged to refer to the handout before asking for assistance. We hoped this would allow them to replicate the tasks independently at home. To achieve our overall aim of building up group members confidence in using computers, we targeted: 1. Opening documents Word and photographs 2. Closing documents 3. Saving Word documents and photographs 4. Shutting down the computer 5. Cutting and pasting items. Table 1 shows the targets for each session. During a final session, each group member was asked to complete a picture based feedback sheet, although one participant was unable to attend that day due to illness. The remainder of the session focused on the group members coming together to participate in a recreational team activity. With such small numbers the results (table 2) are not entirely clear-cut, but they illustrated that all group members found the group enjoyable and that the majority of members would welcome the opportunity to do a further course. The feedback also suggests that the majority of members considered the course to be pitched at the right level and all members found the computer group interesting. We therefore feel that running a similar course would be highly appropriate. Although on the whole the course ran very smoothly, a number of issues arose which we would need to bear in mind in the future: 1. Running the course away from our clinical base causes a few problems, for example not having all our resources to hand. 2. Given the post-course feedback, we feel that future courses should continue to be run with one patient per computer, with the option for them to share if they prefer. 3. Difficulties co-ordinating hospital transport causes problems for the clients and impacts on staff time. On

two occasions one therapist had to wait with a patient for two hours until the hospital transport arrived. 4. Including group members who need assistance with toileting removes a speech and language therapist from the course. 5. Because PowerPoint was not successful, we would need to decide how best to disseminate information to the group as a whole. 6. Part-time speech and language therapists have difficulties committing time to an intensive course. 7. There are difficulties in planning such a group as each member learns skills at different rates. 8. We need to have at least two members of staff per five members to run the group. In the future we could consider involving speech and language therapy assistants, students or volunteers, or maybe even approach a local college to set up a partnership for running the course. 9. Each group member needs a large workstation to site their computer, adaptive mouse and the handout in a suitable position. These workstations also need to be accessible for wheelchair users.

Figure 1 Pre-course rating scale

Invaluable resource
However, as a direct result of planning and implementing this course, our service now has an invaluable resource in the handouts we prepared. Since the course, we have provided many other clients with copies of these handouts and they too have found them useful. Making the handouts highlighted just how many steps are involved in completing the simple tasks we were teaching. There are many ways to successfully complete the tasks, but equally just as many hurdles that may cause difficulties. The pre-course rating scales showed that some clients had little insight into their own computing skills. For example, one member rated himself as highly confident in all operations which the course planned to cover. However, throughout the course he asked for considerable help and was clearly under confident in all four areas. In future we would want to actually observe patients operating a computer as well as asking them to rate their own ability. Our course improved all group members confidence in basic PC operations. By the end every member was considerably more autonomous in using their computer and both members and their partners reported that these skills were carried over to the home environment.

Table 1 Session targets 1 Opening Documents Closing Documents Shutting Down the PC Saving Documents Cutting and Pasting Items Table 2 Post-course feedback
Member 1 Member 2 Member 3 Member 4

Did you enjoy the group? yes Would you do another? yes Was the group more fun than previous PC groups? yes Did you like working alone? yes/no What should be the maximum number of people in the group? 3 How easy was the course? right level How interesting was the course? v. int

yes yes yes yes

yes no no no 2

yes yes yes yes 1

No response

right level right level easy

v. int

int

v. int

REFLECTIONS DO I OFFER TRAINING TO ENABLE CLIENTS TO MAKE THE MOST OF NEW TECHNOLOGY? DO I MAKE THERAPY MORE MOTIVATING BY PERSONALISING IT TO A CLIENTS INTERESTS? DO I STRUCTURE COURSES TO GIVE SUFFICIENT OPPORTUNITY FOR REPETITION AND PRACTICE?

Resources
The Windows XP operating system, and Word and PowerPoint software are all brand products of the Microsoft Corporation, www.microsoft.com.

Reference
Cottrell, S. & Davies, A (2004) Supporting conversation, providing information, Bulletin of the Royal College of Speech & Language Therapists 630 (October), pp. 12-13.

Vicky Styles (pictured above left) and Sarah Woodward (above middle) are speech and language therapists at the Computer Assessment and Training Service, Communication Aids Centre, Frenchay Hospital, Bristol, BS16 1SE, www.cacfrenchay.nhs.uk/res_enable.htm, e-mail Sarah.Woodward@nbt.nhs.uk. Alex Davies (above right) is a community speech and language therapist based at Cossham Hospital.

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