Speech and language therapy is a relatively new discipline. The profession was born some 50 years ago, uniting those working with mostly head injured soldiers returning from the second world war. Interest in communication at that time was lead by neurologists, ear, nose, and throat surgeons, and many teachers. As in many other disciplines, the foundations of the profession were based on concern for those with the disorders and an empirical approach to remediation.We undertook a literature review to establish the state of knowledge about the efficacy of speech and language therapy in major client groups and to identify important areas for research.' Not surprisingly, in view of the profession's youth, research has dealt more with the analysis and identification of speech and language disorders and the development of hypotheses underlying therapeutic programmes than with evaluating their efficacy, relevance, and validity.We wanted to take a systematic approach to reviewing the research,2 but there are not enough controlled studies for us to confine ourselves to this approach. We therefore extended our review to studies displaying the state of knowledge and the main therapeutic challenges.This review attempted to cover a broad range of published and grey literature and hence required interrogation of many different databases because the literature related to speech and language therapy appears in journals covering linguistics, psychology, social sciences, and education. Other reviews examining the efficacy of speech and language therapy have not reflected the wealth of literature because they have limited the search to Medline and associated medical databases.' The main findings of the review are summarised in the box.

SA survey was conducted to investigate the prevalence of speech and language problems in people receiving care from the Mental Health Unit of a District Health Authority. A screening assessment was devised with the aim of detecting difficulties with receptive and expressive language, voice, articulation and fluency, by use of modified standardised tests and subjective ratings. All in-patients who had been in hospital for longer than six months were screened, as were all day patients attending the Integrated Rehabilitation Workshop in the hospital grounds and a random sample of patients attending two day centres in the community. Results showed that moderate or severe difficulties in at least one aspect of speech and language was present in over two-thirds of the 138 people assessed. The most common problems occurred in the tests of comprehension and naming. A quarter of those assessed had problems with spontaneous speech. Problems with voice, articulation and fluency were less common. The limitations on the information obtained due to the nature of the population considered and the assessment procedure, and the implications of the findings for the management of patients are discussed. Une enquite a e'tt faite sur la fre'quence des difficultis de Iangage et d'e'locution chez les sujets soigne's par I'unitk de sante' mentale d'une administration de district britannique de la sante' publique. En utilisant des tests standardise's modifie's et des estimations subjectives, une &valuation de dkpistage a permis de de'tecter les difficulte's de Iangage rkceptif et expressif; de voix, d'articulation et de fluidite' verbale. Tous les malades hospitalise's depuis plus de 6 mois ont kte' e'value's, ainsi que tous les patients externes suivis par l'atelier de re'adaptation intkgre' dans l'enceinte de l'h6pita1, et qu'un kchantillon au hasard de patients suivis par les deux centres de jour du district. Les rksultats ont re've'le' l'existence de difficultks moyennes ou se'vlres chez plus des deux tiers des 136 personnes kvalutes, en ce qui concernait nu rnoins un aspect du langage et de I'klocution. Les probllmes les plus frkquents avaient trait aux tests de cornpre'hension et de de'signation. Un quart des sujets avaient des dificculte's d'e'locution spontante. Les proble'mes de voix, d'articulation et de fluidite' ttaient moins frkquents. La discussion porte sur les limites des renseignments obtenus, dues ci la nature de la population ktudie'e et ci la mkthode de l'enqulte, et sur ce que les rksultats laksent entrevoir en ce qui concerne l'encerdrement des patients. Eine Umfrage wurde durchgefuhrt, u m die Haufigkeit von Sprech-und Sprechschwierigkeiten unter den Menchen festzustellen, die bei der psychiatrischen Abteilung einer regionalen Gesundsheitsbehode (Mental Health Unit of a District Health Authority) in Behandlung sind. Ein Uberpriifungsverfahren wurde mit dem Ziel entwickelt, rezeptive und expressive Sprachschwierigkeiten sowie Stimm-, Artikulations-und Sprechflufiprobleme aufzedecken. Modifizierte Standardtes...

This study investigated the perception and experiences of people with speech impairments and of the general public when communicating with speech impaired people. The aim was to identify the actual concerns of people and factors that make communication easier or more difficult, to inform treatment programmes and information. A triangulated approach was used. Discussion groups were held with members of the public, in-depth interviews were conducted with speech-impaired people and an experimental study examined encounters between speech-impaired people and shop workers. In a partial replication of the work of Crow (1988) the views of speech-impaired people were elicited by a questionnaire. Concerns identified in group discussions related to the importance of time and the need for information. The experiment suggested that the type of speech impairment might influence attitudes. Findings from the questionnaire and the interviews emphasized the importance of taking time and being assertive. The limitations of the findings and the possible service implications are discussed.

SFew speech and language therapists work with psychiatric patients. This study investigates how the specific communication problems of this population are addressed by care staff: Following a survey to determine the prevalence of speech and language problems in a psychiatric population, subjects assessed as having moderate or severe dificulties were selected for further study in order to investigate how they were currently being managed by thepeople responsible for their care. Key workers or charge nurses were interviewed, and ward and department nursing care plans were examined for mentions of speech and language problems, for aims in connection with these problems and for strategies to achieve these aims. Speech and language problems were not mentioned in 40% of the nursing care plans inspected. Where speech and language problems were mentioned there were aims in connection with half of these and strategies to achieve the aims in only 10% of the sample. The reasons for failure to mention speech and language in nursing care plans and for discrepancies between the results of speech and language therapy assessment and assessments of ward and department staff are discussed.