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SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2004 (

Readers have asked for more feedback
days. Here, we travel to Las Vegas, Edin
about a toolbox for school-aged childr
Therapy and a variety of projects in the
How I
am keeping
Louise K. Frazer left Scotland for
Barbados five years ago and works on a
private basis as a paediatric speech and
language therapist.
Further information on Johansen Sound
Therapy from Camilla Leslie, 10
Kingsburgh Road, Edinburgh EH12 6DZ,
tel/fax 0131 337 5427, e-mail
Camilla.leslie@johansensoundtherapy.com,
www.johansensoundtherapy.com.
For details of the North Eastern Speech
& Language Therapists Association see
www.nesta25.com. The Silver Jubilee
Conference From Training to Practice
was held on 12th November 2003
near Newcastle.
(direct, indirect), reinforcement (immediate,
delayed, occasional, self), location (where is
therapy taking place), listener (who is present).
Talk about stammering with your client. Do
some stammering together. We need to be able
to stammer with our clients so that we can explain
to them how to do things either without stam-
mering or when you are stammering. Try out
some repetitions, prolongations and blocks. Play
with stammering and the level of tensions.
Secondary behaviors tend to disappear as the
child begins to ease instead of push (see page
26).
We should not be telling our clients that some
sounds are harder than others to produce. It is not
about the specific sounds - more about the per-
ception. Instead of saying which sound is hard to
produce, ask the child where in their speech
machine does it feel hard - lips, tongue and so on.
Nina introduced the idea of the Speech Triad. I
found this particularly useful when remembering
all of the goals that we should be working on. The
three sides are communication, beliefs and feelings
and speech management.
1. Communication
Discuss turn taking, and make your client aware
that they have time to think about what they
want to say.
Always introduce eye contact into therapy sessions.
Eye contact increases the speakers feelings of
confidence, as well as demonstrating that the
speaker is comfortable communicating. Try
activities during role-play. The children I work
with often have poor eye contact - especially at
the moment of the stammer. More eye contact
leads to more confidence and more confidence
hen you are working on an Island
with only a few other therapists, it
is important professionally and
personally to attend gatherings of
other like-minded people. In July 2003 I was lucky
enough to go to the 20th National Lingui Systems
Conference in Las Vegas, along with a large num-
ber of paediatric speech and language therapists
from all over the United States and Canada. The
seminar that had most impact on my practice was
A balanced approach to school-age stuttering
therapy by Nina Reardon, a stammering specialist.
I am often at a loss over where to go with some of
the school age stammerers. Their therapy is usually
a long haul - they have sometimes had therapy
from an earlier age and no change has been noted.
Since attending Ninas seminar, I have used the
tools she outlined with three different clients.
All three boys are aged from 8-10 years and have
not had any intensive stammering therapy before.
They have enjoyed discovering new things about
their stammers and have become experts about
stammering difficulties. They feel much more con-
fident about stuttering and within therapy sessions
there has been a noticeable decrease in their
stammers. The parents have also commented on
how much better their speech is at home.
We know that our goal is not for perfect fluency.
We should be aiming for more fluency. Do we tell
our clients and families this? Are they expecting that
miracle from us? We should be aiming to give our
clients effective communication. The child needs to
accept that they stammer and know that both stam-
mering and managed speech are OK. Therapy needs
to activate the childs ownership of stuttering.
Therapy needs also to be meaningful to the child.
As therapists, one of the tools we can give our
clients is to be their own therapist. During the
process of intervention it is important for speech
and language therapists to create opportunities
for long-term success from the very first moment
of therapy. So there is really no such thing as
transfer and maintenance activity - all the things
we do from the first moments of therapy are
transfer and maintenance activities (figure 1).
Before we start, we need to discuss our therapy
with the client, parents, teachers and others.
We do not need to count stammers - this is too
variable. It can be done on entry and exit to the
therapy programme but not on a weekly or daily
basis. Changes can be documented in a speech note-
book. Ratings can be given by therapist and client at
the end of each session: On a scale of one to ten,
where do you think your talking was today?
The underlying concepts of therapy are:
Hierarchies - discuss what is least difficult / most
difficult. Draw ladders or stairs to represent this.
Desensitisation - the fear of stammering
needs to be decreased.
Self-monitoring, analysing and reinforcement
(Did I stutter then? Was that a hard stutter?) The
child is becoming their own speech and language
therapist, and monitoring their own speech.
Variables to be manipulated, for example:
length and complexity of utterances, formulation
(imitation, picture naming, reading), model
The tools of the trade
For Louise Frazer, working
with school aged children
who stammer was a particular
challenge - until she found
the right tools for the job.
v
SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2004
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leads to more eye contact.
Teach the child how to resist time pressures - if
they are encouraged to use wait-time prior to
commenting or answering a question, it will
decrease the rate of communication, increase
formulation time, increase the time the child
has to use the tools you are teaching them
and, importantly, decrease the tension in the
speech muscles. Encourage the client to count
to two in their heads - slowly!
Reflective listening is not a skill we are born
with. Repeating or rephrasing the message
delivered to you as the conversational partner
lets the client know that you have got the idea
but also that, if the message did not come
through correctly, they can repair it. Use reflective
language to your client like, So what I heard
you say was... or You are telling me that...
2. Beliefs and feelings
Beliefs and feelings need to be addressed. We
need to have a good rapport with our clients so
they will tell us how they feel about their speech
and their communication in general. The children
will experience more long-term success in dealing
with stuttering if we help them understand that
they can be great communicators whether or not
they stammer.
Let your client do some stammering research.
Tell them some internet addresses related to
stammering and ask them to find out ten things
about stammering. (Some good sites, along with
the British Stammering Association - www.stam-
mering.org - are these American ones:www.stut-
teringhomepage.com,
www.WeStutter.org, www.friendswhostutter.org,
www.stutteringhelp.org.)
Figure 1 Checkpoints for success in transfer and maintenance
As a therapist, ask yourself at various stages of therapy:
Have we established an awareness of fluency?
Have we begun the process of acceptance of stammering?
Have we activated the childs ownership of stammering and the therapy process?
Have we given the message to the child that both stammering and managed speech are OK?
Have we used a conversational context as much as possible?
Have we made therapy meaningful to the child?
Have we got out of the clinic setting as much as possible?
Have we worked through the variables that can be manipulated?
Have we involved the clients parents, teachers and others?
Have we helped the child to self-monitor?
Have we developed resistance to fluency disruptors?
Have we prepared the child for possible relapse and told them that this is part of
stammering - it is not a failure?

ck from conferences, courses and study

dinburgh and Newcastle to hear more
dren who stammer, Johansen Sound
the North East of England.
ng up-to-date
3. Speech management
Speech management includes fluency enhancing
techniques, stuttering modifications and the inte-
gration of both.
Before we start on techniques, we have to think if
the particular child needs every tool. Nina suggests
packing a toolbox with the client - draw one in the
speech book so you can add new tools as they
come up. A child needs many tools but, once they
have them, they can adapt and change them when
necessary. Try and make therapy meaningful by
thinking about the childs interests, curriculum rel-
evancy (use classroom topics) and communication
environments. Always check-in with your client
by asking questions like, How did you feel about
that? or Do you like easy starts?
We need to help our clients develop an under-
standing of the process of producing speech. They
should be aware of how speech is made and what
can cause it to break down. They need to understand
speech before they can change it. To help with
this you can draw a man and label the parts needed
for speech. Talk about the whole process - from
lungs and vocal folds up. Let the child touch their
throat when they make voiced and un-voiced
sounds. Get them to say ahla then ask, What
did you feel moving? then get them to say,
Papa and ask, What is moving now? Talk
about the normal flow of speech and then talk
about what happens when this breaks down. Talk
about the tension in the muscles.
Techniques for easier speaking include:
1. Light contacts
This helps keep the tension away by utilising softer or
lighter contacts between articulators. Demonstrate
tight / loose so the client can see and feel the difference.
2. Easy starts
Encourages tension to decrease. You are not
encouraging the child to slow talk. Easy starts
decrease tension, increase sense of control over
speech mechanisms at the start of speaking and
indirectly decrease the rate of speech and commu-
nication. Demonstrate with a ball - throw it with a
lot of tension in your arm, now do it relaxed.
3. Pausing / Phrasing
This is normal for all of us to do when we talk. Make
sure your clients know that we all do it. Using
longer pauses between phrases helps decrease the
rate of communication, increases the time to use the
tools and decreases tension in the speech muscles.
The profile of the curve is considered more important
than the level of hearing, although referral to audi-
ology would be made for a child showing a hearing
loss. The aim of the therapy is to bring the audio-
gram as close to the ideal profile as possible and the
effect of these improvements should be seen in lis-
tening and language skills, but may also be seen in
other areas such as motor skills and concentration.
Questionnaires for parents probe the current
attention, behaviour, coordination and language of
the child. Laterality of hands, feet, eyes and ears is
checked. Audiometry is used to establish a hearing
profile through monaural thresholds followed by
ear advantage through binaural pure tone
audiometry. This is followed by dichotic listening
tasks, where CVC combinations are played
through headphones into one or both ears. These
tasks include listening to and repeating a CVC
combination played into one ear without becoming
distracted by a different CVC combination played
into the other ear.
Johansen Sound Therapy normally takes nine to
eleven months to complete as, although short-
term, intensive training has an immediate effect,
this diminishes quickly and is not maintained. It aims
to change the architecture of the auditory cortex,
moving the hearing profile as close as possible
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SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2004

tones. This imbalance is often found in children

and adults after recurrent middle ear infections in
the early years, and in people with reading and
spelling problems with a diagnosis of dyslexia.
Dyslexia is Kjeld Johansens main area of interest
but both he and speech and language therapist
Camilla Leslie (who oversees Johansen Sound
Therapy in the UK) believe it can bring at least
some benefit to all children assessed as requiring
speech and language therapy.
Audiometry is an essential part of Johansen
Sound Therapy assessment, so anyone following
through their attendance at the course will need
to purchase an audiometer (cost around 800). It
is unlikely that audiologists would be in a position
to do the audiometric assessment, as what
Johansen Sound Therapy regards as signs of prob-
lems with listening often fall
within the normal range of
hearing.
Ideal hearing curve
Thorough testing produces a
listening profile. This is con-
sidered against the ideal
hearing curve (figure 1) and,
if there are any deviations,
the child is a candidate for
Johansen Sound Therapy.
ntuitively it makes sense that auditory deficits -
not picked up through an ordinary hearing test
- could underlie at least some speech and lan-
guage impairment. Readers have been asking
for more information about auditory processing
and sound therapy and, having featured it in the
magazine (Robinson & Leslie, 2001; Treharne et al,
2002), I was sufficiently intrigued to sign up for a four
day Johansen Sound Therapy course with its founder,
Dr Kjeld Johansen, the Director of the Baltic Dyslexia
Research Laboratory in Denmark.
There are many different types of sound therapy
making a variety of claims, so consumers and
therapists can be excused for feeling a little con-
fused. The field suffers from two credibility problems.
Firstly, it is not generally accepted within the
mainstream academic community, so research has
been somewhat idiosyncratic. Secondly, because it
operates outwith the mainstream, it is usually only an
option if clients are willing to pay. Kjeld is however
unequivocal about the ethos of the Johansen approach:
We want to help kids, not become millionaires.
Kjelds rationale is based on the concept of central
auditory processing. While audiologists are interest-
ed in the ear and neurologists are interested in the
brain, sound therapy proponents are interested in
the system leading from the inner ear to the brain.
Right ear dominance is considered crucial to the
efficiency of input to language centres which, even
for the majority of left handed people, are located
in the left hemisphere of the brain.
If the balance between the right and left ear is
not correct, symptoms can include sensitivity to
background noise, difficulties discriminating
language sounds, hyper-sensitivity in the low
frequency range, too little sensitivity in the high
frequency range, fairly large differences in thresh-
olds between left and right ears, and left ear
advantage for language sounds and / or pure
This is appropriate whatever the tool.
We sometimes think as therapists that we will
eliminate all stammers. We have to rethink this
and remember that the child will still stammer,
especially once he leaves the therapy room, so
lets give him some techniques to help him be
more fluent and stammer more easily. These are
techniques to ease out of a stammer, rather than
push through with it. The client needs to be
aware that they can fix it and they have a choice
- to ease out instead of pushing through:
1. Cancellations
This happens after the stammer has occurred.
Once they stammer, the child will pause long
enough to analyse the moment of stuttering,
release tension, and return to the word to produce
it in a modified way (such as with an easy start).
2. Blockouts
A variation of cancellations. The child needs to
take control during the moment of the stammer,
to learn to stop in the moment of the stammer,
pause (analyse, relax) then start again.
3. Pull-Out
Taking control during a moment of stammering.
This makes the stammer turn from something
involuntary into something voluntary. We can
imagine this to be like a slide. The stammer starts
at the top of the slide, and as we think of going
down the slide, we slide out of the stammer.
4. Voluntary Stuttering
Involves using purposeful, under-control stam-
mering to decrease fear, involuntary tension and
avoidance of stuttering. It also helps the client to
be more open about stammering and desensitises
them to moments when they do stammer. You can
then ask the child how it felt to stammer.
So, you now have the tools and ideas. Adapt your
own techniques, add some of these - and good luck!
Suggested reading
Chmela, K. & Reardon, N. (2001) The school-age child
who stutters: Working effectively with attitudes and
emotions. Stuttering Foundation of America.
Manning, W. (2001) Clinical Decision Making in
Fluency Disorders. (2nd Ed) San Diego, CA:
Singular Thompson Learning.
Shapiro, D.A. (1999) Stuttering Intervention: A collab-
orative journey to fluency freedom. Austin, Tx: Pro Ed.
Zebrowski, P.M. & Schum, R.L. (1993) Counselling
parents of children who stutter. American Journal
of Speech-Language Pathology 2:65 - 73.
A sound therapy?
Can CDs of music with certain
frequencies dampened or
amplified to stimulate an
individuals listening skills
lead to improvements in their
speech and language? Avril
Nicoll sounds out Johansen
Sound Therapy.
Figure 1 The optimum hearing reference curve
(See Tomatis, A.A. (1991) The Conscious Ear. New York: The Talman Company.)
Optimum hearing reference curve......
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PLEASE STAND BACK TO LET OTHER PASSENGERS
DETRAIN
(notice at Newcastle Station, 2003)
Girls, girls, always wear your earrings - your face
comes alive, and people will talk to you.
(Kay Morrison, Edinburgh lecturer, recalled by
Morag Horseman)
In 1978, the North East Speech Therapists
Association (NESTA) was formed to provide low
cost training in the north east of England and to
support newly qualified therapists, especially
those working single-handedly. As the examples
above also show, while our language and our
profession continue to evolve, sometimes the
The other therapist there, Alison Taylor, is keen
to discover ways of helping her third child Emily
cope better with learning. She had been trying
another sound therapy with inconclusive results,
and I caught up with her recently to find out how
Johansen Sound Therapy is going:
I must admit this must be the easiest and most
enjoyable form of therapy I have participated in.
Emily doesnt need much prompting to go and listen
and is getting much better with left and right -
probably a result of putting the headphones on.
After listening to Waves 4LFR for 7 weeks I thought
her comprehension when reading to herself and
when I read to her had improved. This was con-
firmed by the audiogram. Initially there was a big
dip at 3000Hz but now the right ear is on the correct
line. Spelling has improved in tests. She used to be
in the bottom three in her year but actually won
a prize for the best terms learnt spelling in her
group. She has made 12 months progress in 8
months, but still has a long way to go. Emily
appears now to be working things out more for
herself, as in jokes. It will be interesting to see
what happens after listening to a customised CD.
References
American Speech-Language-Hearing Association
(2004) Auditory Integration Training. ASHA
Supplement 24 (in press).
Robinson, N. & Leslie, C. (2001) My Top Resources.
Speech & Language Therapy in Practice. Winter.
Treharne, D. (2002) From sceptic to convert, the objec-
tive way; Lane, C. (2002) A.R.R.O.W. hits the bulls-ear;
OConnor, K. (2002) Enthusiasm, knowledge - and a set
of headphones. All in How I use therapeutic listening.
Speech & Language Therapy in Practice. Winter.
Resources
Dr Alison S. Hood, Orthoptist, Eyescan (UK), tel. 0141 637
7503, e-mail Alison.eyescan@talk21.com.
SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2004 ;
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towards the ideal curve. This is done incremental-
ly by listening for 10 minutes a day through head-
phones to a music CD which has had certain fre-
quencies dampened or amplified by a certain
amount according to the clients individual profile.
Usually the right ear is stimulated more than the
left ear. Initially, and in other instances where a
reliable audiogram cannot be achieved due to age
or hearing problems resulting from a cold or glue
ear, standard rather than customised CDs are used.
Neutralised CDs are used for a few left handers
where you suspect language may be processed in
the right hemisphere. Children are reviewed every
six to eight weeks, with CDs changed as required.
A good quality CD player (personal or other) and
headphones are essential. The CDs cost from 13 -
26 each, with the average number required
around four.
Caution is required in some circumstances, for
example with children who are left handed or suf-
fer from epilepsy, or when combining sound thera-
py simultaneously with other treatments that could
overstimulate a child. When listening to the CDs
children should not be eating, have background
noise or be doing any language-based activity. Kjeld
says Johansen Sound Therapy has the best chance
of stimulating the brain when clients are aged from
3
1
/2 to 9 years. It has, however, been used with chil-
dren of all ages, adolescents and even adults up to
around 70 years of age, although with adults it
takes longer for the effects to become apparent.
Kjeld does not claim that Johansen Sound Therapy
is a panacea. The many factors which can contribute
to childrens difficulties - genetics, the perinatal peri-
od, health, socio-economic status, family, critical life
events, behaviour / personality and education -
mean that for each child a different balance of inter-
vention will be needed. An unexpected bonus of the
course was a fascinating presentation by orthoptist
Dr Alison Hood on the signs and symptoms of visual
anomalies which can contribute to reading failure,
and how these can be ameliorated.
Research encouraged
The American Speech-Language-Hearing
Association has put out a position statement
(2004) on what it refers to as Auditory Integration
Training (specifically including the Berard method,
Samonas Sound Therapy and Tomatis method). It
concludes that it has not met scientific standards
for efficacy that would justify its practice by audi-
ologists and speech-language pathologists. It
adds, However, well-designed, institutionally
approved, research protocols designed to assess
the efficacy of AIT are encouraged. It is recom-
mended that this position be re-examined should
scientific, controlled studies supporting AITs effec-
tiveness and safety become available.
It would be disingenuous to say that everything
we ever do with our clients is evidence-based. For
one thing the evidence we have access to and use
depends on many things - experience, training,
environment, beliefs, interpretation, peer pressure,
even (as Lord Hutton might say) the subconscious.
However, three speech and language therapists
were among the individuals attending the course,
and they had an open-minded but questioning
approach, constantly looking for verification of
effectiveness. Anecdotal evidence from people
who have extensive experience of Johansen Sound
Therapy - such as emerging sub-groups of hearing
profiles which match presenting features like autis-
tic spectrum disorder and specific language impair-
ment - is promising, but more specific research by
the speech and language therapy community is
needed. The changing audiogram is clearly useful
as an outcome measure and, because this approach
is so different from traditional therapy, one of the
therapists attending is planning to set up a control
group alongside her treatment group.
Past meets present
The North Eastern Speech &
Language Therapists
Association was formed 25
years ago to provide low cost
training for speech and language
therapists in the north east of
England. Avril Nicoll finds the
energy, drive and vision of the
founder members mirrored by
the current cohort.
practice were among the hot topics, with recruit-
ment and retention a strong sub-text.
Morag Horseman, one of NESTAs founder mem-
bers, recalled the early days of her career. A
profession split between health and education
and isolated by the medical officers policy of
keeping speech therapists apart. Taking the bus
with a Grundig reel-to-reel tape recorder and
heavy bags, and fellow passengers - miners on
their way to work - carrying her bags along to one
of her schools. Her departments policy in 1954
not to employ married women or, if they did, to
keep them on without any rights. No incentives
for married women with children to return to
work, and no refresher courses when they did.
Going into a new post, and being handed equip-
underlying issues they address remain the same.
And at the conference celebrating NESTAs Silver
Jubilee, training, support, skills, research and
development, collaboration and evidence-based

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SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2004 8
ment including a home-made metronome. The
excitement of the arrival of the Reynell
Developmental Language Scales, a revolution at
the time.
Morag says that, The older you get, the more
important your past becomes. This is as true for
the profession as it is for us as individuals. By
recording what we are doing, and sharing our
experience, we pay due respect to the pioneers
and pave the way for the speech and language
therapists of the future.
Sometimes, even now, members of our profes-
sion are pioneers. Sarah Glenwright has been set-
ting up a speech and language therapy service in
mental health. She says that, for a new service, you
need at least a month in post with no therapy
appointments. You need to find out from other
people what services already exist, and how
speech and language therapy might fit in,
although people are not always clear on this. She
suggests shadowing therapists in other areas who
are working with a similar client group, and con-
sidering a job share arrangement for this kind of
development rather than a single person. A specif-
ic interest group can also provide much needed
support and guidance. In Sarahs case, the mental
health SIG is looking at organising a buddy sys-
tem, and putting together a pack which will cover
funding, references and clinical issues.
Sarah has had to be very focused as it would
have been impossible to do everything at once.
Now that her service is up and running, she wants
to consider research into what it is that speech and
language therapists do that is different from other
members of the team. She also wants to look into
quality of life outcome measures which will show
where we have been able to be effective. As an
example, she quotes a 76 year old lady with mem-
ory and word finding problems who, following
her involvement, has the same problems but is no
longer avoiding situations such as going to the
hairdresser and using the phone.
Sometimes, whatever we try, we feel frustrated
and unhappy, and unable to see a way through
with particular clients. One of Jo Borrellis clients
would say, I want to do _____, and do it now, and
this isnt helping me. She found they were both
battling to set aims and to be in charge. The
solution was transactional analysis, a counselling
technique which has concepts consistent with the
rehabilitation concepts of progression from
dependence to independence.
Sometimes we dont know what a client is capable
of because we lack appropriate assessments, training
and multidisciplinary teams. Selena Mathie praised
the Sensory Modality Assessment and Rehabilitation
Technique (SMART) as a consistent and in-depth tool
for establishing whether or not a client is in a persis-
tent vegetative state. Her use of television material
featuring a young woman was a poignant reminder
not to make assumptions based on single visits, assess-
ments or reports. It also showed clearly the tremen-
dous value of music therapy, as music can reach
someone in the way other communication cannot.
Passion and determination
Sometimes the difference between success and
failure is down to our own passion and determi-
nation. This was the case for Mary Greetham &
Rachel Baker when they successfully introduced
the Picture Exchange Communication System
(PECS) to secondary school aged children. Their
service delivery model can be applied to any sys-
tem not just PECS. The speech and language
therapists initiated the idea with the head
teacher, who arranged the first meeting with
staff. Therapists showed the PECS video and
related it to children in the school. Targets were
set for staff, including having a PECS coordina-
tor in the school, and at the second meeting staff
identified four children aged from 14-18 years.
The therapists sent a letter to the head and the
class teachers giving the times of nine sessions
over six weeks with named therapists, the need
for a member of staff from the class, the room
size and a questionnaire regarding motivators for
that child. Staff took on board the need to make
resources and symbols for their own classes, and
the school have ordered PECS resources.
Sometimes a client group is significant, but thin
on the ground, and therapists with specialist knowl-
edge even more so, particularly in rural or less heav-
ily populated areas. The North East Regional
Dysfluency SIG (known as NERDS) provides support
for therapists at any level of experience who are
working with people who stammer. They meet
every two months, with the focus rotated between
paediatric, adult and joint issues. This SIG grew out
of a recognition that ongoing support was needed
and that, while specialist skills are not available in
every trust, access to such support is essential.
So far, the SIG has developed a telephone support
network and a fluency continuing professional
development module run by specialists which
aims to build a portfolio of skills and emphasises
practical activities. Eight areas across the north
east of England are involved. In future, the SIG is
planning to get accreditation for the module, to
develop modules for older children and adults,
and to run cross-district groups for people who
stammer.
Sometimes we have an idea but we cant do it on
our own. Karen Dixon, Barbara Storey & Colin
Sawyer (a speech and language therapist, artist and
computer programmer) have developed a multime-
dia resource which they hope will be the first of
many. My own kids and their friends are computer
junkies used to games which involve television char-
acters and sell in their thousands. They have tried
out Listening and Rhyming and really enjoyed it,
both on-screen and in printed-out worksheets.
There was a relaxed, informal, supportive
atmosphere at this conference, with speakers
given time to explore their topic and the audience
given time to ask questions about subjects of
interest. This was best in the adult-orientated ses-
sion I attended, where there were smaller numbers
of delegates. Poster presentations added to
knowledge of the area and the services it is devel-
oping, and exhibitors gave delegates hands-on
time with their products.
Sometimes a conference really works.
Resources
Leaps and Bounds Multimedia Ltd: Phonological
Awareness Series Disc 1: Listening and Rhyming
is available for 45 tel. 0191 413 1818, e-mail
gill.blissett@btopenworld.com. Disc 2: Syllabification
will be available in Summer 2004.
PECS (including courses): Pyramid Educational
Consultants UK Ltd, Pavilion House, 6 Old
Steine, Brighton BN1 1EJ, tel 01273 609555,
www.pecs.org.uk.
Reynell Developmental Language Scales: Now
on their third version, completely revised by
Susan Edwards, Paul Fletcher, Michael Garman,
Arthur Hughes, Carolyn Letts & Indra Sinka, from
NFER-Nelson, 451.75, see www.nfer-nelson.co.uk.
SMART: Sensory Modality and Rehabilitation
Technique by Gill-Thwaites (1997). Details from
Royal Hospital for Neurodisability, London,
tel. 020 8780 4568.
Transactional Analysis: Eric Bernes Games
People Play (1970), published by Penguin
ISBN 0140027688.

My Top Resources (back page): references

1. Access to the joint voice clinic
Laryngograph Ltd, tel 020 7387 7793,
www.lx@laryngograph.com
2. Instrumental voice analysis systems
Fourcin, A. (1986) Electrolaryngographic
assessment of vocal fold function.
Journal of Phonetics 14: 435-442.
Laryngograph Ltd, tel 020 7387 7793,
www.lx@laryngograph.com
Speechviewer from PAS UK Ltd, tel
01635 247724.
Kay Elemetrics (1986) Nasometer manual,
Kay Elemetrics Corp. USA.
3. Normative voice measures
Aronson, A.E. (1990) Clinical voice
disorders: an interdisciplinary
approach (3rd Ed) New York: Thieme.
Baken, R.J. (1996) Clinical Measurement
of Speech and Voice. Singular Publishing.
Wilson, D. (1987) Voice problems of
children. (3rd ed) Baltimore: Williams
and Wilkins.
Mathieson, L. (2001) (6th Edition)
Greene and Mathiesons The Voice
and its Disorders. Whurr.
Andrews, M. (1986) Voice Therapy for
Children. San Diego: Singular Publishing.
Andrews, M. (1995) Manual of Voice
Treatment: Paediatrics through Geriatrics.
San Diego: Singular.
4. Voice therapy concept cards
Dean, E.C., Howell, J., Waters, D. & Reid, J.
(1995) Metaphon: A metalinguistic
approach to the treatment of phonological
disorder in children. Clinical Linguistics
and Phonetics 9 (1). (This forms part of
a clinical forum on Metaphon, pages 1-58.)
5. Vocal Profile Analysis Training
Laver, J., Wirz, S., Mackenzie-Beck, J. & Hiller,
S. (1988) Vocal Profiles of Speech Disorders.
Research Project. Phonetics Laboratory,
Dept of Linguistics, University of Edinburgh.
6. Access to the internet and library resources
KA24: http://stlis.thenhs.com/hln/ka24/
UCL library: http://library.hcs.ucl.ac.uk/
ICH library: http://www.ich.ucl.ac.uk/library/
10. Augmentative communication systems
www.makaton.org
Kapitex Healthcare Ltd, tel 01937
580211, www.kapitex.com