Therapy in Practice Series – serie

The aims of this book are to increase awareness of speech development and skills and to explore some means by which improvements may be achieved when those skills are absent or disrupted. The contents include current thinking from research and recent literature, management techniques particularly designed for students and newly qualified therapists and comments considered helpful to parents, teachers and carers. The book discusses the production of speech and how it works and highlights the relevant genetic and structural deviations from normal development which may lead to the production of disordered speech. It then considers what can go wrong with human neuromusculature and motor planning to prevent the acquisition of intelligible speech and makes reference to types of disorders of fluency in children and discusses current therapies. The text then considers voice disorders in children and clinical management is detailed for this and all other disorders dealt with. Adolescent and adult speech difficulties comprise the remainder of the book.This book is aimed primarily at helping speech therapists and speech therapy students to direct their attention to the non-linguistic aspects of speech and particularly to emphasize the need for physical "readiness" which is necessary to precede the acquisition and development of language.

This book is written primarily for occupational therapists and occupational therapy students but will be of relevance to anyone working with clients with rheumatoid disease. It is hoped that the text will communicate the challenge faced by therapists to establish management programmes appropriate to the identified needs and priorities of the individuals with whom they work, the potential to utilize a wide range of skills and the opportunity to contribute to the understanding of the many unanswered questions which remain in relation to rheumatic diseases. The aim of this book is to present an holistic approach to the management of rheumatoid disease, considering first, the ways in which rheumatoid disease can affect a person's life and then looking at the approaches and techniques used by therapists to minimize these effects. This approach has been chosen as it is fundamental to both the philosophical basis of occupational therapy and the manage­ ment of a chronic progressive disease. An holistic approach considers the physical, psychological, social and spiritual aspects of a person and the ways in which these have been effected by an underlying disease process. Each of the components are interrelated, illustrating the complexity of establishing appropriate management programmes and evaluating their effectiveness. The first two chapters consider the effects of rheumatoid disease on clients and their families. An holistic approach identifies the need for a diversity of skills to be available to both the therapist and client.

Counselling is a practical activity. The aim of this book is to offer a practical framework to enable those who work in the health profes­ sions to develop a range of counselling skills. It will also offer a theoretical grounding that may serve to inform counselling practice. The book is aimed at any of those people who work in the health professions: nurses, medical staff, occupational therapists, physiotherapists, speech therapists, soeial workers, teachers of various sorts and voluntary workers. It does not seek to provide information speeific to the work of those groups but aims at demysti­ fying counselling and making the skills involved available to them all. The book assumes that the professional working in a particular group will already have their own body of knowledge regarding their work. This book will supplement that knowledge and extend the range of caring skills. Throughout the book, practical examples of the prineiples under discussion are offered. These help to make the abstract concrete. They also serve to apply the skills described to a variety of health-care settings. A problem arises over gender and trying to avoid sexist language. I have been unable to find a solution to it and have referred to the counsellor as she and the dient as he. No sexism is intended but the usage may have made for darity and ease of reading.

This book, of interest to all professionals who work with people with motor impairments, describes the gross and fine motor skills which are necessary when writing, drawing or using a keyboard. It describes areas of ability and impairment which should be investigated when assessing special needs in regard to the environment,tools and modes of recording on paper. The remaining chapters discuss the variety of handwriting and drawing tools, typewriters and word processing systems which are commercially available as well as equipment which is specially designed or has been adapted to suit those who have a motor impairment. In addition to this book, the author also wrote the first book in the "Therapy in Practice" series, "Occupational Therapy for Children with Disabilities".

Multiple sclerosis (MS) is a chronic neurological disease, where myelin in the brain and spinal cord becomes inflamed, damaged and hardened into scar tissue. The nature of the disease and the problems it poses to affected individuals and their families leads to the involvement of many different health professionals in their care. This book will be of use to professionals concerned with day-to-day advice, help and support of people, and their families, with multiple sclerosis. It is practical and aims to guide readers on the latest and most effective approaches to the management of MS. The text emphasizes the relationship between the practitioner and the patient and includes the experiences patients and their families have had with the health-care system along with their reactions and responses to the intervention.

It is both a pleasure and a privilege to be invited to contribute a foreword to this book, which deserves - and needs - to be read by virtually everyone who is concerned with the treatment and subse­ quent welfare of the victims of severe injuries of the brain. Some friends, relatives and workmates might be helped by reading some parts of it, but, if the book has the effect it deserves to have on therapists, nurses, doctors, and others working in both hospitals and the community, these laymen will be suitably informed and assisted by one or more members of the necessarily large therapeutic team. The improvements in methods of resuscitation that have taken place during the last 40 years or so have abolished the previously fatalistic readiness to accept that a week or two in coma after a head injury was virtually a sentence to death from pneumonia. After it had become possible to save lives it gradually became clear that survival of the patient was not necessarily followed by recovery of the brain and that the price of success, in saving lives, was a popula­ tion of cerebral cripples that was increasing at the rate of 1000 or more a year throughout the country. Although this figure has remained about the same for more than 20 years, there has been a great improvement in the amount of interest, the standard of care and the quality of results that are being achieved.

In the current era of cost awareness and the pressure to free hospital beds as rapidly as possible, coupled with the move towards community care, there is increasing emphasis on returning and main­ taining disabled people in the community. Often, many health and welfare workers are involved in this process. Occupational therapists however have a particular role to play. Their training is such that they are able to assess and treat the physical, psychological and social aspects of a disabling condition. This enables them to help disabled people to achieve their maximum ability in the environment in which they live. Whether the occupational therapist is hospital or community based, employed by the health or social service depart­ ment, her caseload is often vast. The occupational therapist may specialize in a particular age group or disability, but it is more likely that she will have to work with a wide age range from the very young to the very old. Assessment of needs and the subsequent provision of equipment and adaptations is the greater part of the OT's job. Other aspects include counselling the disabled person and his family and planning future intervention must often, however reluctantly, be given a low priority. In spite of staff shotages occupa­ tional therapists are frequently called on to provide the client and other groups of workers with advice and information on all aspects of living with any disability.

The philosophy of normalization and promotion of the plight of children and adults with mental handicaps has drawn more public attention in recent years. Governments in a number of countries have embarked upon policies involving the dosure of institutions, move­ ment of people with mental handicaps back into the community, and development of community-orientated programmes, although their reasons for this may be economically, rather than ideologically, motivated. Occupational therapists have moved into the community, along with other health professionals, in order to set up community services for people with mental handicaps. My own experience of working in a multidisciplinary team in Central London for 2V2 years, helping adults with mental handicaps to move out of an institution, has been a source of motivation to write this book. The amount of written material available on the occupational therapy approach to re settlement and de­ institutionalization is limited, in comparison with the massive amount of information written by, and for, other practitioners. Additionally, the number of texts written by and for occupational therapists with this dient group are few. Despite excellent support from OT colleagues, I experienced considerable frustration trying to define and perform my role, not helped by a shortage of texts to draw on.

My aim in writing this book was to provide a guide to management for student occupational therapists and practitioners in the field. It is not intended to provide an answer to every conceivable management situation. The organization and delivery of health and social services is being subjected to relentless scrutiny and change. Hardly has one proposal been implemented before another one is introduced. In view of this, the thrust of this book is to highlight key points to be addressed when looking at the delivery of occupational therapy services. For this reason, the book starts from the viewpoint of one who is in the early stages of an occupational therapy career through to the position of having to manage the staff in an occupational therapy departmentl service. Following this plan, the book has been organized into two parts. Part One covers issues that an occupational therapist has to confront directly in any job situation. In this situation, she will need to know wh at is expected of her. Apart from knowing about the various duties, it is necessary to understand the context in which these duties are to be conducted. Hence, there are chapters that discuss professional responsibilities, self-management, stan­ dards of practice, and the structure of the two biggest employers of occupational therapists - the NHS and local authority social services departments.

This book is both an introductory text to the rehabilitation of stroke for student therapists and a reference text for qualified therapists. The layout of the book reflects these needs with Chapters 1-4 assuming a minimal level of understanding of the material. These chapters provide an introduction to the condition of stroke itself, the problern therapists face in assessing and treating stroke patients and therapeutic approaches in occu­ pational therapy. Prognosis of stroke is also discussed which is an issue taken up in later chapters concemed with expert systems. The use of microcomputers in occupational therapy is discussed throughout the book with particular reference to their direct role during therapy. Chapters 5-7 assume a higher level of understand­ ing from the reader although students will find the material useful as an insight into the work of the modern-day therapist. Chapter 5 addresses the work carried out in the area of biofeedback; Chapter 6 introduces the concept and uses of databases, and Chapter 7 discusses the versatility of microcomputers, especially in the provision of expert systems for the prognosis of stroke.

Contrary to popular belief, practice of physiotherapy with elderly patients is no easy option. In addition to grappling with the effects of multipathology it presents problems of accommodating to the patients' altering physiological state and the accumulating life events of older age. There are challenges of ethics in decision making. In therapeutic management it is sometimes hard to know where to begin, what to try, and when to stop or offer something eise. The work offers both satisfaction and despair, frustration and enormous interest. Despite the existence of many specialist textbooks on medicine and physiotherapy, it is widely feit there is a place for a basic guide to physiotherapy with elderly people. This book aims to provide guidance and insights based on the writers' experience, as weil as from the current literature. Good practice must be holistic in its breadth of knowledge and attitude to the individual, but meticulous in attention to detail in examination and treatment as for a patient of any age.

The decision to write this book was taken by a group of practising speech therapists who worked with bilingually language handi­ capped children in the UK. They formed a professional interest group called the Specific Interest Group in Bilingualism because of the need felt by speech therapists to have some forum for discuss­ ing the challenges posed by the assessment and treatment of the bilingually language handicapped. In these regular discussion groups it became clear that similar experiences were encountered by all speech therapists working with these client populations up and down the country. They centred on managing the linguistic diversity, the need for develop­ mental language information, the need for appropriate assessment protocols, the recruitment of bilingual staff and appreciating the positive perspective of working in this field. In the UK the range of languages is extensive. Italian, Spanish, Portuguese, Greek, Turkish, Polish, Ukranian, Hong Kong Chinese, Vietnamese Chinese, Creole, Black English, Bengali, Gujerati and Panjabi cover the main ethnolinguistic groups. In the 1987 ILEA language census over 140 languages were recorded as being spoken in London.

Part of a series this book is aimed at therapists who are concerned with rehabilitation in a very broad sense. The author argues that most people, given a little time have the personal experience to enable them to help others to improve their interpersonal skills. It is aimed at anyone in the health professions who is concerned about enhancing their own or others interpersonal competence. It offers both theory and guidance in practice and contains many practical illustrations of how-to-do-it as well as a longer illustrative package that tries to convey the running of a typical interpersonal skills workshop. Whilst the book is primarily written for tutors, trainers and lecturers in the health professions, it may also be useful to the clinical practitioner who wishes to develop expertise in helping patients and clients to enhance their interpersonal skills. In the fields of social work, health visiting and psychiatric nursing, there are numerous occasions in which the development of conversational and social skills can help improve personal performance and self-awareness.The awareness of basic counselling and group skills can also do much to improve the quality of communication between people in families and organizations.

The majority of amputations in the western world today are due to vascular disease. Despite the advances in surgical treatment of this disease, particularly by reconstruction, it is a sad fact that the number of amputations performed in these countries each year for vascular disease is increasing. Most of these amputees are elderly and their life expectancy is short, so it is important that the treatment and rehabilitation that they receive is informed, appropriate, efficient and swift to enable them to return successfully to life in the community for their remaining years. Management of this group of patients has proved to be successful only if a multidisciplinary team approach is adopted. Until recently in the UK, this approach sadly has only been implemented by a few centres. However, with the publication of the McColl report into the prosthetic and wheelchair service in 1986, interest in the care of the amputee is growing throughout the country. This book covers all aspects of amputation from disease and diagnosis to rehabilitation and community discharge with emphasis on the man­ agerneut of the largest group, the vascular lower limb amputee. A team approach is described and emphasized as being essential for good results and subsequent successful return into the community. The role of each of the important disciplines is described in relation to the appropriate part of the rehabilitation phase.

This volume represents a painstaking and scholarly introduction to the management of children and adults who have problems of communi­ cation related to, or in addition to, mental disorder. It is a relatively unexplored field having received scant attention until recent years, but the quality of the work included here gives a clear indication that the area should move from the periphery into a main­ stream position in the education and practice of speech therapists. Although all students in training receive some teaching in the area of psychiatry it tends to be limited to a brief consideration of the role of the psychiatrist, and clinical psychologist - very rarely the speech therapist. It has been proposed that the education of the speech therapist who intends to enter this difficult but rewarding field should be developed at post graduate level and there are strong arguments given in this volume to support the idea. Claims that the field is neglected during initial training are, however, well founded and this volume should alert those responsible for the education of speech therapists to this deficiency.

Written primarily for occupational therapists, this text explores the range of groupwork activities used within occupational therapy practice. Part one tackles theoretical aspects, while part two considers practical approaches to group managment. The text includes specific chapters on how to plan, lead and evaluate a group. Guidelines are provided on how to approach some of the common problems which arise in groupwork.

Stress is a feature of all of our lives. The business of working in the health professions means that we are constantly being exposed to stress. That stress can sometimes be enriching and motivating. It has often been pointed out that stress can be positive or nega­ tive. When stress is positive, it rarely needs any further attention. When it is negative, it is a problem. The first aim of this book is to discuss the various sorts of stress that may be experienced by a variety of health professionals, including social workers, nurses, doctors, physiotherapists, occu­ pational therapists and others. What they all have in common is that they work closely with other people - people who often have emotional problems or problems in living. Working with other people who are troubled in this way is indeed stressful. For too long it has been assumed that health professionals should 'get on with it' and put up with any stress that is involved in caring for others. The second aim of this book is to offer practical ways of coping with negative stress. These methods range from simple relaxation techniques, through meditation to methods that involve discussing stress with others: counselling, co-counselling and group work. All the methods described in this book have been used with a variety of health professionals, and not all of these methods will necessarily appeal to you. One of the fundamental points about stress is that it tends to affect each individual idiosyncratically.

This text draws together the principal issues related to the identification of language difficulties in pre-school children. Factors closely associated with the development of language such as cognitive skills, play, behaviour and hearing are discussed. The basic principles underlying early identification, the role of the parent and the issue of early identification within the context of public health are also included. To reflect the range of related professionals involved with language impaired children, there are chapters written by a health visitor, a psychiatric social worker and speech and language therapists specializing in hearing loss. This book should be a useful reference for all those professionals working with children in the health and education setting. This book should be of interest to practising and student speech therapists, nurses, health visitors, paediatric nurses, nursery leaders, play group leaders, clinical medical officers, educational and clinical psychologists.

Rehabilitation of adults with acquired neurological impairment is a vast area of clinical practice. It taps the expertise of many different health care professionals, and this has led to the multidisciplinary or "team" approach to assessment, treatment and management. However, clients frequently complain of the failure of professionals to meet their needs in a co-ordinated way. Not only do professionals need to form an intergrated team, but this team must involve the client as a primary member of this team. This book describes in practical terms how health care professionals can work together to identify and meet the client's needs.

This book is written with occupational therapy students in mind, as a guide to newly qualified occupational therapists and for those returning to work after a break in service. Over the years I have been asked many times by newly appointed staffwhether I could recommend a book to prepare them for working with orthopaedic patients. I hope this small volume will fill the gap in the literature on the subject, and that it will be useful as a quick reference book. I hope it mayaiso fall into the hands ofthose in other disciplines and enable them to understand and appreciate the contribution of the occupational therapist to the rehabilitation team. This is the era ofjointreplacement, with ever-increasing demand forprimary and revision surgery. Improved implants and improved surgical techniques are constantly being researched. Surgery for bone tumour is less mutilating and more hopeful than ever before. Operations to release tendons and soft tissue contractures, tendon transfers, osteotomies, spinal fusion, joint fusion, etc. are performed on patients with neurological problems, thus improving function and appearance and preventing further deformity. These are some examples of procedures in this exciting and fast-developing field, while hospital beds are occupied for an ever shorter period of time and the potential for occupational therapy is enormous. 'If surgery is to be successful, the importance of assessing the patient as a human being cannot be over-emphasised' (Souter, 1987). This is precisely the approach of the occupational therapist.

Those suffering with perceptuo-motor difficulties are often described as being clumsy. The latest research shows that the problems associated with this condition frequently persist through adolescence and into adult life. This study has been designed to help children, adolescents and adults by providing practical information to solve the problems that occur throughout life. The book briefly covers theory and remediation in childhood. The real focus of the text is on adolescence and adulthood. Adolescence is a particularly sensitive stage, with comments and attitudes of peers seeming especially important. School, community and home life are considered. Routines skills that the majority of us are able to perform with little thought or effort are covered: posture and personal appearance, choosing and sustaining an appropriate career, coping with domestic and child care activities, leisure pursuits and hobbies. A glossary of terminology, addresses of suppliers of equipment and societies with an interest in the problem are included.

This book is about practical ways of enhancing communication between health professionals and their patients or clients and between those professionals and their colleagues. The text covers all aspects of verbal and non-verbal communication. Divided into four parts, communication skills are identified as educational, therapeutic, organizational and personal. Within these areas teaching, presentation, computing, listening and counselling skills are discussed. There are also chapters on running groups, general management skills, self presentation, improving writing skills, assertiveness and self awareness. The final section includes a skills checklist and questionnaire. This volume should be of value to nurses, doctors, occupational therapists, speech therapists, physiotherapists, and social and voluntary workers, both qualified and in training, who want to improve their existing communication skills.

Analysis and research on relationships;Communities and social networks;Social skill and social competence;Increasing competencies;Evaluating change.

As part of the pre-registration education for students who intend to enter health care work, periods of work experience are bullt into the curriculum. Students are placed in work settings, generally termed clinical settings, for specified periods, ranging from single days to extended periods of time. Ouring these placements the students are 'supervised' by qualified staff whose first responsibility is to the care of patients. It is therefore important that provi­ sion is made to support these clinicians in their role of teaching and super­ vising students. Initiatives have therefore been taken to enhance clinicians' knowledge and skills in the teaching process. The principles and procedures to be used in the supervision and teaching of students are generic in nature and therefore applicable to a number of fields. This book has been prepared for use by a wide range of professionals in health fields. There is particular attention to chiropody/podiatry, dietetics, occupational therapy, orthoptics, physiotherapy, speech and language therapy and radiography, although the principles covered are also applicable to a wider spectrum of professions. The content draws on the experience of clinicians and teachers and will, it is hoped, help to disseminate the good practice which already exists.

The client group referred to as the long-term mentally ill, the persistently severely mentally distressed, the chronically psychotic ill, or people with long-term mental health problems have generally received a poor deal from the traditional psychiatric services. Help has largely rested on custodial and medical treatments. The main focus of rehabilitative ap­ proaches has often been dictated by predetermined expecta­ tions which are usually set quite low. The assumption is often made that people in this client group are 'treatment resistant' and unlikely to make good use of opportunities to develop personal skills towards restructuring their lives. Though the emphasis of treatment has often followed medical approaches, and many non-medical people have sought to lay blame on the medical model (as characterized by diagnosis and medical treatments), it would be wrong and greatly over-generalized to follow this line of criticism entirely. In reality, some psychiatrists have been the pioneers and advocates of the diversity of approaches to community support, medical and non-medical. It is they who have often supported the development of other professionals and non-professionals and who often lead the pioneering efforts of research into methods of treatment and support.

Spinal cord injury produces a unique multiplicity of problems which must be clearly understood by the considerable numbers of health care and rehabilitation professionals involved in their lifetime management. This book assumes an educational approach to spinal cord injury management, in which the individual becomes an active participant in goal setting, problem solving, and in assuming self responsibility. Rehabilitation is discussed in terms of client empowerment, client-professional partnerships and examines the client in the context of his unique socio-cultural environment. This book attempts to present an educational and psychosocial model for the rehabilitation of people with spinal cord injuries. In line with this approach, the first chapters present a concept of empowerment in rehabilitation and of an educational view of the process of learning to live with a suddenly acquired disability. The medical aspects of spinal cord injury follow, with a study of aetiology, impairments, acute care, disability reduction and engagement in self care activities.The management of high lesions in a rehabilitation context is examined separately, since this is a highly specialised area and one which is largely ignored both in therapy literature and in professional practice. The final chapters focus upon psychological issues, and upon such issues as productivity, leisure, socialization which are important both in early phases of management and in the long term.

Acupuncture is now practised widely throughout the world. Some use acupuncture for its pain relieving effects, and others use it as part of traditional Chinese medicine. This book addresses both aspects of acupuncture and demonstrates its practical application in clinical treatment. This is the first book on acupuncture written for physiotherapists and physical rehabilitation practitioners, and is also suitable for reference for acupuncture students.

The features of this book include: the use of interactive video as a training medium; facilitating the transfer of training to work contexts; the communication audit and its role in quality assurance in health; working with groups as a communication strategy; defined and expanded practical exercises for trainers.