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This chapter addresses the (pragmatic) language and communication difficulties of adults who are in prison. While there are no systematic studies of speech, language and communication difficulties in adult prisoners, conditions which are strongly associated with communication difficulties such as dementia, learning difficulties and psychiatric conditions are shown to be prevalent in this population. In addition, low levels of education and literacy difficulties are frequently revealed in studies of adult prison populations. By contrast, there is far better recognition of the communication needs of foreign national prisoners. Many of the communication difficulties that are specific to the prison environment for foreign national prisoners apply equally to a home language speaker who has speech, language or communication difficulties. These difficulties are detrimental to the individual and may also reduce the effectiveness of the prison regime given that most assessment and treatment to prevent re-offending is verbally mediated. Risk assessment relies particularly on effective communication with the prisoner. If communication difficulties prevent full disclosure of risk factors, risk assessment will be of limited value and may affect not only the person but also staff and other inmates. The chapter highlights many areas where further research into adult offenders is needed and presents a policy agenda to improve health care provision for older prisoners.

Young offenders disproportionately present with Developmental Language Disorder and are likely to struggle with the communication demands of the justice system. Professional guidance outlines strategies for facilitating successful communication, but it is unknown to what extent recommendations are substantiated by evidence. This review mapped academic and grey literature regarding the communication requirements, barriers and recommendations for routine youth justice interactions, such as forensic interview and courtroom testimony. Academic papers were identified through searches of five online databases, and OpenGrey, Google Scholar and organizational websites were searched to identify grey literature. 75 of 505 retrieved papers met inclusion criteria. Extracted data were presented regarding a) requirements and barriers a young person would encounter in the youth justice system, b) communication recommendations made for each stage of this journey, and c) type of evidence underlying the outlined findings. Communication barriers included exposure to unfamiliar vocabulary, repairing misunderstandings, constructing narratives and displaying the appropriate attitude. Recommendations were wide-ranging and broadly consistent, though very few had been evaluated for effectiveness. Some papers queried the practicality and effectiveness of recommendations such as rephrasing difficult terminology. A relatively small number of papers considered the views of young offenders or observed real youth justice interactions. Future research should include observational studies of real youth justice interactions to evaluate the effectiveness of widely recommended strategies. Policymakers may wish to consider concerns raised that rephrasing the language used in the youth justice system is not practical or sufficiently effective, and that broader changes to the communication environment are required.

Background: Knowledge of the discourse performance of non‐brain‐damaged individuals is critical not only for its differentiation from disordered expression but also for more accurate models of ageing and communication. The effect of ageing and cognitive skills on the cohesive adequacy of discourse has, until now, presented a confusing and ambiguous picture. Aims: To examine comprehensively the effects of both age and cognitive skills on the discourse cohesion of 32 non‐brain‐damaged males divided into four age groups. Methods & Procedures: A large body of narrative and procedural samples (394 samples) was elicited from the participants. Their cognitive skills were determined using three tests, whilst their discourse cohesion was analyzed and correlated with the cognitive test results. Outcomes & Results: This extensive investigation of ageing effects on discourse cohesion and their relationship to cognitive behaviour did not provide neat generalizable results. It showed that ageing significantly increases the number of cohesive errors and reduces the quantity of referential ties in picture‐sequence narratives. The changes with age were limited to two aspects of cohesion and not linear across age groups. The participants’ cognitive skills declined with age. Correlations between some cognitive tests and certain cohesive changes suggest co‐occurring deficits rather than a causal explanation of cohesive decline with age. Conclusions & Implications: With ageing there are increased cohesive errors and decreased referential ties, co‐occurring with declining cognitive skills. This study yields important guidance for future research, suggesting that picture‐sequence narrative is the most effective tool for clinical evaluation of discourse, but also that findings from one discourse sample may be misleading.

Background: At least 60% of young people in the UK who are accessing youth justice services present with speech, language and communication difficulties which are largely unrecognized. The contributing reasons for this are discussed, suggesting that early language difficulty is a risk factor for other problems such as literacy difficulties and educational failure that may increasingly put the young person at risk of offending. Opportunities for identification and remediation of language difficulties before young people reach youth justice services are also outlined. Aims: To examine language skills in a sample of children in a secure children’s home aged 11–17 years. Methods & Procedures: A sample of 118 males were routinely assessed on four Comprehensive Evaluation of Language Fundamentals (CELF) subtests and the British Picture Vocabulary Scale (BPVS). Outcomes & Results: Around 30% of the participants presented with language difficulties scoring 1.5 SD (standard deviation) below the mean on the assessments. Despite them entering the home because their vulnerability was recognized, only two participants had a previous record of language difficulties. A total of 20% of the participants had a diagnosis of mental illness, 50% had a history of drug abuse and 31% had looked-after status prior to entry to the home. Conclusions & implications: Children experiencing educational or emotional difficulties need to be routinely assessed for speech, language and communication difficulties. More population-based approaches to supporting the development of oral language skills in children and young people are also supported. Keywords: language impairment, adolescents, speech and language therapy.

Background\ud \ud While the prevalence of language and communication difficulties among young people in custody is well established, holistic understanding of the complexity and co-occurrence of additional vulnerabilities among this population are rare.\ud \ud \ud Methods\ud \ud Ninety-three young people in a young offenders institution in England were assessed using the Comprehensive Health Assessment Tool, the Test of Word Knowledge, and a range of additional assessments of communication, cognition, and neurodevelopmental difficulties.\ud \ud \ud Results\ud \ud Forty-seven percent of the young people demonstrated an aspect of language skills significantly below the population average, with more than one in four identified as having impairment. Only one in four of those with an impairment had previously accessed speech and language services. Language needs were associated with difficulties with social communication and nonverbal cognition, as well as higher risk of self-harm and substance misuse.\ud \ud \ud Conclusions\ud \ud Earlier identification of language difficulties requires routine assessment of young people at risk of engagement in offending behavior. Where language difficulties are identified, holistic assessments of needs should be undertaken. There is a need for speech and language therapy provision within youth justice services, as well as in other services accessed by young people at risk of engagement in offending.

The purpose of this research was to ascertain the views of staff and managers within a youth offending team on their experiences of working with a speech and language therapist (SLT). The model of therapy provision was similar to the whole-systems approach used in schools. The impact of the service on language outcomes is reported elsewhere (Gregory and Bryan, 2011). A questionnaire was sent to all staff asking about their experiences related to working with a speech and language therapist. Eight telephone interviews were then conducted to explore the questionnaire findings further and to gain a management perspective on speech and language therapy within a youth offending service (YOS) team. Staff were largely positive about their experience of working with a SLT. Understanding the nature of the presenting communication difficulties and having strategies to manage these were linked to improvements in wider working practices, which managers linked to culture change. The whole-systems model of service delivery appeared to have potential application to youth justice contexts. Direct access to the SLT to support communication aspects of their work was particularly important to the YOS staff. Further research is needed to examine the optimum model of speech and language therapy in youth justice settings, and the potential contribution to criminal justice outcomes such as prevention of re-offending.

This study examined the effects of right brain-damage (RBD) on oral discourse production using a multi-layered discourse processing model. Narrative and procedural discourse samples from participants with RBD and no brain damage were analysed in terms of seven broad areas corresponding to the processing levels of the model. Participants also completed attention, cognitive, general communication and RBD assessments. Despite their normal performance on all assessments (except those on attention), the participants with RBD demonstrated statistically significant differences in syntactic complexity, clarity disruptors and dysfluencies, as well as in discourse grammar and clausal structure in the narratives and in cohesion in the procedures. A model-based theoretical explanation accounting for the deficits noted in participants with RBD, together with clinical guidelines, is provided.

This paper discusses the implementation and evaluation of an interaction-focused intervention single case study for a couple where one partner has aphasia. Drawing on conversation analytic research, naturally occurring conversations of the couple at home pre- and post-intervention were collected and analysed. Analysis of the speaker with aphasia's topic initiating turns in the pre-intervention conversation showed that in each case a feature of the attempt was that the speaker had difficulty in getting the topic initiation accepted and established. Drawing on conversation analytic work on topic initiations in normal conversation, intervention focused on training the couple to co-produce these topic initiating turns of the speaker with aphasia in a collaborative and step-by-step manner. Post-intervention, there was evidence that the couple were now using this new method, albeit in a slightly different way to that worked on in the intervention sessions. Drawing on work into adaptation by speakers with aphasia and their conversation partners, these results are discussed in terms of a process of mutual adaptation by the couple.

Background : The field of pragmatic impairments of verbal communication in cerebrally damaged subjects dates back almost three decades. However, a systematic investigation of pragmatic competences has never been completed in a large sample of normal adults controlling for age and education factors. Aims : We aimed to examine the effects of age and education on the main features of pragmatics of verbal communication in a large sample of normal healthy subjects. Methods & Procedures : We developed an Italian version of the Right Hemisphere Language Battery devised by Bryan (1995) and administered it to 440 normal volunteers. Ages ranged from 20 to 79 years, and education corresponded to Italian levels of education. Outcomes & Results : We found that ageing and low education influenced performance on almost all the subtests of the I-RHLB. In particular, performance dropped at 70–79 years, particularly in those with the lowest level of education. Conclusions : These results suggest that processing of the pragmatic features of verbal communication parallels the decline of other cognitive functions associated with ageing and low education that previous studies have already established.

In this paper, we reconsider some of the processes that distinguish production and comprehension. In particular, we discuss the specific forms of thinking involved in each: "thinking for speaking" and "thinking for listening" (Black & Chiat, 2000; Slobin 1996). We argue that thinking for speaking (or for any form of language output) crucially involves schematisation or "paring down" of conceptual information (Dipper, 1999) a process partly driven by the language system itself. Thinking for listening, on the other hand, involves an "enrichment" of skeletal conceptual information derived from the linguistic input, using pragmatic principles. Production and comprehension involve distinct forms of interaction between thought and language, and should not be characterised as a simple reversal of the same processes. This approach allows us to account for different patterns of production and comprehension in non-fluent aphasia, and predict some of the factors that facilitate processing for people with these languages.

Previous research on work after stroke has used quantitative methods and a medical model approach to identify factors that influence return to work. This study uses an inclusive, qualitative methodology (focus groups) to begin to explore stroke survivors’ own perspectives about what helps and hinders paid or voluntary work after stroke. The research was conducted in partnership with Different Strokes, a British organisation of stroke survivors. Five focus group discussions were held with 37 stroke survivors and 12 of their supporters. Data was analysed using an adapted Framework approach to identify themes within and across individuals and groups. Factors representing barriers to or enablers of work were identified in four key themes: rehabilitation process, employer agency, social structural and personal. The study found evidence of social oppression via infrastructure, institutional structures and practices, and some individuals’ attitudes. Alongside this, some supportive individuals, practices and strategies were identified.

Background: There is no systematic surveys of the UK prison population, but data from several sources suggest that a significant number of prisoners might have limitations in their speech, language and communication abilities. Aim: To examine the hypothesis that compared with the general population, a significantly larger number of the prison population has speech, language and communication difficulties. Method and Procedures: A survey of 10% of the young offenders within one young offender's institution was conducted. Tests of naming, picture description, grammatical competency and comprehension were used. Outcomes and Results: Forty-three per cent of participants scored at a level significantly lower than the limits acceptable for their age on the Boston Naming Test; 73% scored significantly below the acceptable limits for their age on grammatical competency; 23% scored signifcantly below the acceptable limits for their age on language comprehension; 47% of participants received more than one rating of moderate impairment on picture description. Conclusion: It was confirmed that high levels of speech, language and communication difficulties are found among the young offender population. The implications for the management of young offender, the limitations of the study and indications for further research are discussed.

This paper describes the development of a clinically viable tool for the assessment of language and associated cognitive skills in the older population which was instigated by the SIG Psychiatry of Old Age (South of England). A series of sub-tests is described. Data from normal older people is used to establish preliminary means and lower normal limits as a guide to distinguishing performance associated with normal age-related change from performance associated with pathology. The importance of allowing for the effects of normal age-related changes on language processing is illustrated. Data from older people with pathology attending clinics and hospital departments is also presented. Quantitative and qualitative language profiling is outlined. Data analysis suggests that the Barnes Language Assessment is able to profile language skills and difficulties. Indications for further research are discussed.

This paper reports on investigation of the application of the principles of conversation analysis to the non-verbal interaction of an aphasic speaker who has minimal verbal output but moderately well preserved comprehension. The results show that detailed analysis of interaction can highlight the clients abilities as well as clarifying the strategies employed by the non-dysphasic communicative partner, which facilitate interaction. The results were used to advise staff who cared for the client in a residential home on how to achieve positive and successful communication.

Many studies support the notion of semantic and/or pragmatic difficulties in people with mental illness. This paper describes a framework (based on a discourse analysis model) for the assessment and reassessment of communication in mentally ill persons.

This study focuses on the assessment and treatment of the conversations of a couple where one partner has aphasia. The assessment and treatment, informed by conversation analysis, are described, and some implications for the relation between language and psychosocial issues discussed.

The need for staff training and support within the residential sector is now recognised but there are many limitations on implementation. Surveys have revealed high proportions of residents with communication disorders and care staff are likely to be expected to cope with a range of complex communication problems (Bryan and Drew 1989). This presentation will discuss a number of recent initiatives that address staff training and support in this care sector.

This paper reports the first findings of a two year project funded by the NHS Executive North Thames to provide an independent evaluation of Communicate, Action for Dysphasic Adults' training programme for carers of older people with communication impairments. The project comprises an organisational evaluation (January-July 1998) to review the use of Communicate by purchasers nationally and in the North Thames health region, and (from September 1998) a clinical evaluation in North Thames region, to investigate outcomes for communicatively impaired people themselves and for training participants. The paper outlines the research design and progress so far before presenting initial findings. It concludes by discussing the relevance of organisational issues and social science research insights to the forthcoming clinical evaluation.

The aetiology of mental illness is complex and not fully understood. Conditions such as schizophrenia are widely accepted as disorders of the brain but a comprehensive neurobiological account of such conditions remains elusive (Meyer and Feldon 2010). A complex interplay of genetic factors, perinatal exposure to environmental insults, early developmental problems and/or early adversity such as abuse, and lifestyle factors are thought to be involved. Many psychiatric disorders have their origin in adolescence. This is a time of brain development particularly involving the prefrontal cortex (Blakemore 2008). It is also a period of life when individuals may take risks which expose them to jeopardizing that cognitive development, such as smoking cannabis which is thought to contribute to gene expression in some individuals with an underlying genetic susceptibility towards schizophrenia (Barkus and Murray 2010). The aetiology of each of the disorders considered in this chapter will be addressed in more detail within the relevant sections.

The project was developed as a response to requests for help received by Action for Dysphasic Adults (ADA) from staff working in residential homes and from the families of residents with dysphasia and other communication difficulties. They all expressed a need for staff training on how best to help clients and for information on communication disability. There is no statutory provision for training in communication awareness or in disability in residential homes and elderly residents often have difficulty in accessing speech and language therapy services (Maxim & Bryan, 1994). The project aims are twofold: (1) To develop a training package on communication awareness and communication disability which can be delivered to care staff and managers in one single or two half-days; (2) To evaluate the effectiveness of the training package. A training package was devised to develop knowledge and useful skills in communication awareness and communciation disability. It was designed to allow trainees to discover key aspects of communication through discussion, role play and exchange of information between trainer and care staff. ‘Training 1’ explores communication through role play and discussion. ‘Training 2’ uses video material to illustrate communication disability and helping strategies. Optional components on aphasia, Parkinson's disease and Alzheimer's disease can be chosen to suit the profile of the residents at a particular home. All care staff attending training are given a booklet containing key points from the training package. Contact was made with care staff and managers from 16 residential homes for elderly people. These homes reflect the heterogeneity of residential care: public and private sectors, inner city and suburban settings. The homes had varied population profiles. One home was specifically for Asian men and women, another for ‘black elders’; some homes had few residents with communication disabilities, whereas others had a high percentage of such residents. Pre- and post-training questionnaires were devised to obtain information on the home and the perceived benefits of training from managers and care staff. One hundred per cent of care staff and managers found the course useful. Only 50% of care staff had received any training at all for their job and only two homes had already provided training on communication disability. The care staff almost unanimously report better understanding of the normal communication process of residents with communication disability. Most managers and care staff would like more training for all staff, but those on night shifts and part-time staff have difficulty attending training sessions. The booklet and care plans for individual residents are therefore essential aspects of ensuring that all staff have access to useful information. The training package can be given with limited time input from a speech and language therapist. The next stages of the project are: (1) To produce the pack, booklet and video in a modified form; (2) Appoint a project manager to market the training; (3) Set up a training group to train trainers. In consultation with local speech and language therapy managers, trainers will be appointed who are speech and language therapists with previous experience of elderly clients.

Background: Increasing numbers of children with behaviour and school problems (related to both academic achievement and social participation) are recognized as having undiagnosed speech, language and communication difficulties. Both speech, language and communication difficulties and school failure are risk factors for offending. Aims: To investigate the prevalence of speech, language and communication difficulties in a group of persistent and prolific young offenders sentenced to the Intensive Supervision and Surveillance Programme (ISSP), and to provide a preliminary evaluation of the impact of speech and language therapy (SLT) intervention. Methods & Procedures: Seventy-two entrants to ISSP over 12 months were screened by the speech and language therapist. Those showing difficulties then had a detailed language assessment followed by intervention delivered jointly by the speech and language therapist and the youth offending team staff. Reassessment occurred at programme completion. Outcomes & Results: A total of 65% of those screened had profiles indicating that they had language difficulties and might benefit from speech and language therapy intervention. As a cohort, their language skills were lower than those of the general population, and 20% scored at the ‘severely delayed’ level on standardized assessment. This is the first study of speech and language therapy within community services for young offenders, and is the first to demonstrate language improvement detectable on standardized language tests. However, further research is needed to determine the precise role of speech and language therapy within the intervention programme. Conclusions & Implications: Children and young people with behavioural or school difficulties coming into contact with criminal justice, mental health, psychiatric, and social care services need to be systematically assessed for undiagnosed speech, language and communication difficulties. Appropriate interventions can then enable the young person to engage with verbally mediated interventions.

Background: In recent years conversation has become an area of interest for aphasia therapy, with several studies using conversation analysis (CA) to target and evaluate therapy. Most of these studies have focused on the main conversation partner of the person with aphasia, and in particular have targeted the partner's pedagogic behaviours in relation to the person with aphasia. Evaluations of therapy have primarily taken the form of qualitative analyses of change in conversational behaviours. Aims: This single-case intervention study aims to advance research into interaction-focused intervention for aphasia in the following ways: by targeting intervention at the person with aphasia and the main conversation partner as a couple; by focusing on conversational behaviours where the person with aphasia can be seen to be restricted by the conversational actions of the conversation partner, in particular by recurrent questioning using closed questions and yes/no interrogatives; and by using a novel combination of qualitative and quantitative approaches to evaluate the intervention. Methods & Procedures: CA was used to target and evaluate interaction-focused intervention for a couple where one partner has aphasia. Evidence for change was evaluated using qualitative and quantitative evidence of change in conversational behaviours; evidence from naïve raters of pre- and post-intervention conversation extracts; and interview/other feedback from the conversation partner. Outcomes & Results: There was evidence that the intervention had changed the couple's conversational behaviours. In particular, the conversational behaviours of the non-aphasic partner were in general less restricting for the person with aphasia in that she was now using fewer questions and more instance of other types of turns, such as paraphrases. Following intervention the person with aphasia had also changed in that he was now producing turns that had more sentences, or attempts at sentences, and which developed the topic of talk across several of his turns. Conclusions: The study provides evidence that directly targeting the conversational behaviours of the person with aphasia and/or a main conversational partner can produce positive change, and can achieve this in a way that is ecologically valid. In particular, it highlights the usefulness of targeting conversational behaviours that are proving to be maladaptive for the participants. It provides further evidence that creating change in the non-aphasic partner's conversational behaviour may facilitate change in the person with aphasia's conversational and linguistic performance. © 2010 Psychology Press.

OBJECTIVE: There are many issues concerning the assessment of older people from ethnic minority groups, the most significant being the language barrier experienced by those whose English is an additional language (EAL). This study aimed to test the hypothesis that EAL participants would score less well than those with English as a first language (EFL) on the sub-tests of the Barnes Language Assessment (BLA), elucidate the reasons for any such differences and discuss the implications. METHODS: The Barnes Language Assessment (BLA) is an accurate tool providing information about expected patterns of language in different dementia syndromes. This study compares the performance of EAL participants with EFL participants. The BLA was administered to 144 participants, divided into sub-groups with respect to age, gender and educational background, none of whom had a working diagnosis of dementia. RESULTS: Results suggest that EAL speakers performed less well compared to EFL speakers when other variables were matched. Significantly better BLA scores, at the one percent level, were found in both EAL and EFL groups with higher educational achievement for eight of the 15 sub-tests. CONCLUSION: Differences were found in performance on the BLA between EAL and EFL participants. The degree of difference between EAL and EFL speakers decreased as educational achievement rose. The consequences of these findings for service delivery and the problems of recruitment of older EAL participants are discussed.

In 1989, Enderby and Davies discussed the type and pattern of speech and language therapy provision which would be required to service the needs of the speech-and language-impaired population of the UK, on the basis of statistical information drawn from a wide range of sources. In this paper, some methodological issues arising from their study are addressed and an argument made that alternative models of service provision should be considered when planning for future needs.En 1989, Enderby et Davies se sont penches sur le type et la forme un travail orthophonie pour repondre aux besoins de la population, en Angleterre, handicapee au niveau de la parole et du langage, sur la base informations statistiques tirees un ensemble etendu de sources. Cet article traite des problemes methodologiques qu'ils ont souleves dans leur etude, et une discussion est engageee sur la necessite en visager des modeles de remplacement sur le service fourni, dans la planification des besoins futurs.An Handstatistischer Informatio...

A Japanese-speaking stroke patient with disrupted phonology but relatively good semantics was severely impaired in nonword reading, with better preserved and imageability-modulated word-reading in both kanji and kana. This basic similarity of reading in the two Japanese scripts was accompanied by the following differences: (i) distinct error patterns (prominent semantic errors for kanji vs. phonological errors for kana); (ii) a more pronounced imageability effect for kanji; and (iii) a remarkable pseudohomophone advantage for kana. The combination of deep dyslexia for kanji and phonological dyslexia for kana in a single patient suggests that these are not two distinct reading disorders.

PurposeThis paper aims to briefly review leadership within the contemporary UK National Health Services (NHS) including Department of Health and Royal College of Nursing (RCN) initiatives.Design/methodology/approachIt is argued that the concept of clinical leadership is a viable and important one, and is theoretically consistent with the contemporary social psychological literature on the importance of “local” leadership to effective organizational functioning. Field theory proposes that local influences (e.g. local management) on attitudes and behaviour will to a large extent mediate the impact of the organization (e.g. organisational structure and values) on (in this instance) health care delivery.FindingsThe reality of clinical leadership must involve a judicious blend effective management in the conventional sense with skill in transformational change in order to make real difference to the care delivery process.Practical implicationsFor leadership initiatives to become truly culturally embedded into the “way we do things around here”, they require more than just individual training and development.Originality/valueA view is offered for the practical interpretation of the clinical leadership concept in relationship terms. This will involve management of the relationship between health care professionals, between health care professionals and the “organizations” to which they are accountable and between health care professionals and service users.

Aims : This research investigates the relationship between dyslexia traits and nurse performance on a laboratory task designed to assess one of the key cognitive skills involved in drug administration. The potential moderating role of perceived performance control was also assessed, based on previous work demonstrating the importance of self-belief as a facilitator of vocational success. Background : Dyslexia within the health care professions has been the subject of wide and emotionally charged debate but has not yet been scientifically examined. Those who fear clinicians with dyslexia do so because of a presumed or potential risk to patient health and safety posed by dyslexia-induced performance error (e.g. problems with drug administration). Design, sample and methods : 46 nurses (40 student nurses and 6 qualified nurses) volunteered to complete a battery of computerised tasks assessing for dyslexia traits (using four accuracy tasks measuring different types of literacy skill), a paired association task designed to measure one of the key cognitive skills involved in drug administration) and a self-report questionnaire (Learning Styles Questionnaire, self-reported reading difficulty and a history of educational support, perceived control over performance). The performance criterion measure was constructed after detailed job analysis (involving analysis of official documentation, in-depth interviews and field observation across a variety of clinical settings) and involved matching drug names to patient names and vice versa. Results : The results showed that the dyslexia indicators (objective and self-report) were significantly correlated with performance on the paired association task. Contrary to expectation however, the perceived control variable was not associated with performance. Conclusion : The findings provide tentative support for the idea that some tasks might be problematic for the clinician with dyslexia. Taken in isolation however, it would be inappropriate to conclude that this will necessarily translate into true performance errors without taking into consideration the entire performance context. Suggestions are made for replicating and extending the study to provide a more solid and constructive basis for intervention (e.g. support measures, a built-in checking process).

Clinical neurolinguistics still lacks consolidated and standardised tools for the assessment of impairments of pragmatics of verbal communication. In the present paper we present norms of the Italian version of the Right Hemisphere Language Battery (Batteria del Linguaggio dell’Emisfero Destro, BaLED) [1] originally devised by Bryan [2]. The normative study has been conducted with the recruitment of 440 healthy subjects. The battery of tests was not intended to be cognitively oriented, by providing evidence of the cognitive impairments underpinning verbal pragmatic deficits; on the contrary, it permits the detection of the presence/absence of impairments in processing the main pragmatic features of verbal communication traditionally associated with right hemisphere lesions. Thus, apart from being a clinical tool for diagnosing pragmatic impairments of verbal communication, the BaLED represents a useful initial battery of tests for clinical assessment and for selecting specific populations of neurological patients suitable for investigation in further experimental studies.

Language changes are associated with several types of age-related degenerative processes and are known to be particularly stressful for carers. Managing language and communication difficulties in older people has been shown to be an important aspect of dementia care. A test such as the one described here, might be a useful tool for health professionals planning care for older people with possible diagnoses of dementia. The information gained could be used as part of multi-disciplinary team assessment. This paper describes the development of a clinically viable assessment tool for the assessment of language and associated cognitive skills in the older population. Data on 43 normal older people were used to establish preliminary means and lower normal limits, as a guide to distinguishing performance associated with normal age-related change from performance associated with pathology. In the next phase data was collected from 43 older people with possible dementia who were attending clinics and hospital departments. The results suggest that the Barnes Language Assessment can profile language skills and difficulties and may be a useful diagnostic tool to contribute to language assessment of older people. Indications for further research are discussed.

While language facility was once considered to be the sole province of the “dominant” left hemisphere, clinical and experimental findings suggest the right hemisphere plays an equally important role in many language tasks. To elucidate differential hemispheric language processes, Right Hemisphere Language Battery and Western Aphasia Battery data from left (LHD) and right (RHD) hemisphere cerebral vascular accident (CVA) patients and controls were subjected to multivariate discriminant analysis. The highly significant group differences and overall 95% classification rate obtained confirms the utility of the dependent measures in differential diagnosis. Results suggest CVA patients experience disparate language deficits, with the LHD group experiencing concordant-convergent language deficits and the RHD group displaying discordant–divergent deficits that interfere with the receptive and expressive language skills necessary for successful social discourse. (JINS, 2001, 7, 655–664.)

A recently completed evaluation of a one day training package on communication has found evidence of a perceived need for training in both communication and communication impairment among care workers employed by health and social care agencies. This paper is a discussion of the factors that contribute to the delivery of successful workshops to front line care workers.

The potential value of a framework enabling practitioners to conceptualise speech and language therapy from a range of perspectives engendered by different theories about disability is explored. Four disability research paradigms are used to categorise professional activities, whilst the 'individual' and 'social' models of disability are considered as alternative value systems. Challenges facing speech and language therapists in developing roles and services to embrace different perspectives are outlined.

This paper reviews new theoretical and practical developments in working with partners of people with aphasia and describes the development of a clinician's resource entitled 'SPPARC: Supporting Partners of People with Aphasia in Relationships and Conversation'. It focuses particularly on one part of that resource: the SPPARC Conversation Training Programme, which adapts conversation analysis for clinical use. The paper describes the stages involved in assessing and working on conversation in everyday life.

Historical and more recent descriptions of mental illness emphasise the prominent nature of communicative difficulties in persons with these diagnoses (Sims 1995) and a large part of psychiatric intervention is verbally-mediated. Within this study, a theoretically-driven therapy programme addressed the communication needs of two persons with schizophrenia. Significant improvements were demonstrated using valid and reliable outcome measures.

There are many clinical reports of confabulation by schizophrenic patients. This study provides evidence of a form of confabulation by schizophrenic patients in tasks which do not include a memory component. It uses a linguistic framework to analyse the components of this confabulation.

A set of tests was developed to examine areas of language previously described as involving right hemisphere processing. These tests were constructed to be simple to administer and clinically useful. The tests included metaphorical comprehension, the understanding of inferred meaning and humour. A discourse analysis was also performed to investigate whether any language deficits were evident in more functional communication. Testing for aphasia was carried out using the Western Aphasia Battery. Groups of subjects with left or right cerebral hemisphere damage and a group of normal subjects were assessed. The results showed that the right hemisphere damaged subjects were impaired as compared to the control subjects on all of the language tests. However, they were not significantly different on the aphasia test. These results indicate that subtle language problems can occur after right hemisphere damage and these are apparent in functional communication (as assessed by discourse analysis). It is suggested that these language problems particularly concern inability to utilise linguistic information in context. It is further suggested that these language difficulties may account for some of the apparent social and emotional problems following right hemisphere damage.

Groups of right hemisphere damaged, left hemisphere damaged aphasic and normal control subjects were assessed on a series of tests designed to examine discrimination and production of different aspects of linguistic prosody. These included lexical stress, intonation, emphatic stress, lexical stress in sentence contexts, language identification using prosodic cues, and prosody in discourse. The right hemisphere damaged subjects were significantly impaired on all of the tests as compared to the control subjects. Furthermore, they were impaired as compared to the left hemisphere damaged aphasic subjects on some of the tests. The results support the notion that the right hemisphere has an important role in the processing of linguistic prosody.

A programme of therapy for aphasia devised in Finland, Language Enrichment Therapy, was tested in an English version, particularly in respect of its co-operative use by speech therapists and the patients' relatives at home. Although a number of changes were recommended, the method was approved of by therapists and relatives. The majority of patients showed improvement, as assessed by the Western Aphasia Battery, over a period of less than three months with a regimen of one hour a week with the therapist supplemented by an average of five hours of help by a relative at home. These results should encourage the development of programmes such as Language Enrichment Therapy as an economic way of enabling speech therapists to use volunteer helpers.

Recent research suggests that the integrity of the right hemisphere is necessary for the processing of language in context (e.g. Foldi, 1987). A specific case of such processing is the ability to draw inferences from utterances. Studies show that patients with right hemisphere damage (RHD) have reduced ability to draw correct inferences from texts (e.g. Bryan, 1989). Currently there is little agreement as to the cause of this inability. This study adopts a Relevance Theory approach (Sperber and Wilson, 1986) to create a model of utterance processing, from which the cause of difficulties with inference might be deduced. The model serves as the basis for devising 60 bridging inferences on which six RHD subjects and 12 control subjects are tested. The inferences are of three types: textual, textually reinforced and encyclopaedic. The RHD subjects in this study performed worse overall, and in addition performed differentially on the three inference types. The implications of these results are discussed in the light of Relevance Theory, and it is suggested that RHD patients' problems with inference stem from an inability to use linguistic information from the text in the deductive system, coupled with an over-reliance on encyclopaedic information.