Monthly Archives: October 2014

International Stammering Awareness Day 2014: My Shout!

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Raising public awareness is rife these days. There seem to be colourful wrist bands and ribbons for almost every health and social issue you can think of, and stammering is no exception. Today, on International Stammering Awareness Day, you can mark the occasion by sporting a unique sea-green version. It may be a small gesture, but it’s a positive step in the right direction:

We need more awareness around stammering!

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This is true for all people who stammer, but it feels especially relevant for people who have interiorised stammers, like me. I like to think of interiorised stammering as the invisible twin of overt stammering. People with interiorised stammers are able to maintain a near-perfect fluent façade by skirting around difficult sounds and words, and avoiding certain social situations altogether. But while they may appear to speak ‘normally’, this comes at a huge mental and emotional cost. Internally, they are struggling with all the thoughts and emotions that come with having a stammer. Anxiety, fear, frustration, shame, helplessness, loneliness – these are just a handful of those emotions. And they are underpinned by a flood of negative thoughts, such as ‘People won’t accept me if they find out that I stammer’, ‘I need to be fluent to do my job well’, and ‘Stammering means that I’ve failed’.

It’s difficult for people to understand that someone can have a stammer without actually stammering. I remember confiding in an old friend many years ago that I stammer. Her response was both rewarding and devastating: “But you speak perfectly fluently.” I was elated to hear that I had successfully pulled off normal speech, but at the same time it felt very lonely to know that this meant I would receive none of the support and understanding I really needed.

I believe this lack of awareness of interiorised stammering comes in part from an overly simple portrayal of stammering in the media. The King’s Speech – a film that shone a powerful light on stammering – profiles the struggles of someone with an overt stammer. And more recently, Musharaf, from the TV programme, Educating Yorkshire, captured the nation’s attention as a boy with a severe stammer fighting to be heard in a fluent world. While difficulty with speech is a hallmark of all types of stammering, interiorised stammering challenges the perception that this difficulty is immediately apparent. It shows that stammering is actually a very varied condition, and that there is so much more to having a stammer than just talking differently.

International Stammering Awareness Day is a wonderful opportunity for us to raise awareness of these, and other, aspects of stammering. Whether it’s talking about our experiences with others, wearing a wristband or a ribbon, running a marathon, or writing a blog post (!), every effort to improve the public insight into stammering will lead to a better understanding of this condition. I look forward to the day when I can tell someone that I stammer and they nod unquestioningly.

Cara

News Group: Behind the Scenes (2/2)

I wrote last month about how some of our neuro-rehabilitation service users benefit from the experience of attending the news group we run on the ward.

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As a service, we have found that we can use our group provision for a number of purposes:

 

We can use the group to provide different packages of care to different service users within the same session. We may invite people to attend news group as part of their goal-based therapy. For example, they may be working towards a more consistent use of intelligibility strategies, or demonstrating increased communicative confidence by facilitating discussion or presenting a news item as part of the session.

Some people know they are able to participate relatively independently in group conversation. However, they may continue to benefit from support, for example to counter the effects of fatigue or distractibility. Further speech and language therapy (SLT) input for these people beyond discharge from our ward may not be indicated, but there are benefits to them continuing to attend the group while they are with us. This monitoring and maintenance package allows room for fine-tuning and further confidence boosting prior to discharge. Such people are also often positive role models for other group members who may require higher levels of support to engage in group conversation.

Some group members still early on in their admission, or newly referred to SLT by others in the multidisciplinary team, may join us for a number of assessment sessions. This may be because the group setting reveals more interactive skills than they are able to show in the often more transactionally-based ward setting. Alternatively, for some there may be an indication of higher-level language processing or social communication difficulties, which do not impact particularly on the ward. Attending the group allows further assessment of the impact, which their impairments may have in more complex group conversation. It can also provide a concrete starting point from which to discuss these subtle difficulties with the service users who may not themselves necessarily consider any difficulties to be present

Group sessions provide rich observation opportunities for new staff and students. Over the past year, we have been joined by students from nursing, medicine, physiotherapy and occupational therapy. We invite new staff members to join us as part of their induction. The richness of the experience of coming to the group as an observer is that there is the opportunity to meet people with a number of different communication diagnoses, and to see in action the strengths and needs these diagnoses may create. A further positive is that none of our observers is passive; anyone coming to visit our group is invited to participate, thus enriching their own experience and learning, while providing further positive role modelling for our service users. Our own SLT students will often take on facilitation of the group for the duration of their placement, which works particularly well with peer placements.

The news group is a joint project between occupational therapy (OT) and SLT. We have found that we need to meet frequently to review and discuss the strengths, needs and progress of each participant to ensure we keep our input focused. Otherwise, there can be a risk of running a session which goes through the motions of looking at recent news stories, but which gives no specific input to any of the packages of care identified for each service user. I will admit that this has happened at times especially if staffing is low or the ward very busy. After a ‘going through the motions’ session, I feel I have facilitated an opportunity for social interaction and the chance for some people perhaps to take on a bit of information about current news events. However, I also feel that the same session could have been facilitated by an enthusiastic volunteer with no specific training in or knowledge of communication impairment.

News group review has now evolved into a joint SLT and OT review of the needs of whoever is on our ward at any given time, and whether there are other groups we could run. This can often change from month to month as we aim to create group opportunities for the people we have on our ward, rather than to try to shoe-horn people in to a fixed format. For example, in the last fortnight we find we have several people with specific comprehension needs and have this week started a ‘points of view’ group structured with a very low language load, but providing opportunities for interaction and expression of likes and dislikes through music appreciation (a clear split in today’s group between heavy metal and the Jackson 5!), chocolate tasting, TV reviewing and more as we plan it..!

Nic Martin