Learning Disability Liaison Nurses: Transforming NHS patient care for now

Specialist learning disability liaison nurse Jainab Desai is making meticulous checks of the complex arrangements to receive a tricky patient with learning disabilities, with staff of the day surgery unit at Royal Bolton hospital.

She has worked for weeks with staff, family and carers of the profoundly disabled and terrified woman (who needs a vascular procedure).

This is to make sure that the patient will not freak at the entrance to the operating theatre, forcing the cancellation of the operation.

At any time Desai could be co-ordinating the care of up to six people with learning disabilities at Royal Bolton hospital.

This is set to rise as researchers predict that the numbers of people with learning disabilities in the UK will increase by 14% between 2001 and 2021.

They are also 58 times more likely to die aged under 50, often of preventable causes.

The fight to get specialists such as Desai into integrated posts in acute settings has been hard won. She was already in post in 2007 when Mencap's explosive report Death By Indifference, highlighted the cases of six people with learning disabilities believed to have died unnecessarily as a result of receiving worse healthcare than people without learning disabilities. She was a rare breed at the time.

Sir Jonathan Michael's report, Healthcare for All (2008) added fuel to Mencap's campaign by identifying gaps between the law, policy and the delivery of effective services for people with learning disabilities.
Since then progress has been made – 79% of acute settings have a nurse appointed to this kind of role – but there is concern that these roles will be sacrificed in the scramble to reorganise the NHS against a background of service cuts.

Mencap's report earlier this year (74 Deaths And Counting), reveals continued institutional discrimination in the NHS towards people with a learning disability.

The Royal College of Nursing's nursing advisor for learning disabilities, Ann Norman, already knows of cuts to at least four UK's consultant nurse roles (of around 35).

An RCN survey of 500 disability nurses in May showed that three out of four were experiencing cuts in services. Reports from primary care echo this. Norman says: "We are having to run to keep up, to protect frontline services."


How learning disability liaison nurses are transforming patient care | Healthcare Network | Guardian Professional

New changes to GCSE 'will penalise dyslexic pupils'

Ministers have been accused of discriminating against dyslexic pupils by announcing plans to award 5% of marks in GCSE exams for spelling, punctuation and grammar as part of a drive to improve communication skills.

Dyslexia experts, educationists and teachers' unions say the new rules on marking, announced by the Department for Education last month, will penalise hundreds of thousands with a genuine spelling disability and make it more difficult for them to reach target grades.

At the same time dyslexia groups have reported mounting disquiet and confusion among parents and pupils, who are concerned at the lack of trained staff available in schools who can help them overcome their disadvantage and guide them on how to gain extra time, or other assistance, in exams.

In a white paper in 2010, the DfE expressed the government's determination to better equip young people for the jobs market by placing a greater emphasis on spelling, punctuation and grammar in GCSE marking.

It stated: "When young people compete for jobs and enter the workplace, they will be expected to communicate precisely and effectively so we think that changes in the last decade to remove the separate assessment of spelling, punctuation and grammar from GCSE mark schemes were a mistake.

"We have asked OfQual [the Office of Examinations and Qualifications Regulation] to advise on how mark schemes could take greater account of the importance of spelling, punctuation and grammar for examinations in all subjects."

Last month, OfQual announced that for GCSE courses beginning in September, 5% of marks would be awarded for performance in spelling, punctuation and grammar in English literature, geography, history and religious studies.

A spokesman for OfQual confirmed there would be no special exemptions from the marking regime for dyslexic pupils.

However, as was the case previously, a pupil with a statement of special educational needs can gain up to 25% of extra time in exams.

This can also be made available for a pupil with an evidence-backed recommendation from a suitably qualified teacher or psychologist. But the process of attaining extra time is difficult for many pupils and parents, particularly when expert help is not on hand in schools.

One headteacher of a large state comprehensive school said the change would mean that a pupil who had shown a good knowledge and understanding of, for example, history – but who had spelling problems due to dyslexia – could well end up with a worse grade than a good speller who had done less well on the history questions.

Dr Kate Saunders, chief executive of the British Dyslexia Association, said: "We are greatly concerned that these changes may penalise dyslexic individuals. We feel that it is discrimination.

Dyslexic candidates are not seeking advantage but merely a level playing field in order to demonstrate their knowledge and skills. Our continuous efforts to improve conditions have now regressed."

In 2009 the then Labour government announced a £10m package to train 4,000 specialist dyslexia teachers over the following two years after a review of services for children with the learning difficulty, published by the education expert Sir Jim Rose.

The BDA says that many of these specially trained teachers are now being made redundant. It has also had its government funding of £107,000 a year for a helpline withdrawn.

Read more of this article here in the Observer

Specialist Teachers Borrow From Brain Studies

In a corner of a classroom at the Ivymount School, a frustrated 7th grader tells himself to take a deep breath. Slowly, without distracting his classmates, he calms down.

This exercise is among many strategies derived from brain-science research that educators at this private school are using with students with disabilities. In this case, the technique is being taught to students with Asperger syndrome, for whom self-control in a moment of frustration can be elusive.

The five steps to regaining calm—including breathing deeply, reading directions, and telling oneself to give something a try—are taped to many of the desks of students in the Model Asperger Program.

Ivymount is one of a growing number of schools trying to adapt techniques based on brain research to special education settings, a practice that many teachers and parents may not have even envisioned a few years ago.


While some educators remain skeptical, brain research is slowly migrating from the lab into the classroom, both in predicting which students may have learning difficulties and intervening to help students diagnosed with disabilities.

Opportunities Emerge

Among the efforts under way:

• In Cambridge, Mass., a Harvard University center is devoted to training those who want to use neuroscience and cognitive science to improve teaching, including for students with disabilities.
• In Washington, George Washington University has created a doctoral program in applied neuroscience in special education.
• The Center for Applied Technology, in Wakefield, Mass., employs specialists in neuropsychology, along with other experts, to expand learning opportunities for students with disabilities.
• A professor at the Massachusetts Institute of Technology is using brain-imaging to predict which children in a given kindergarten class might eventually struggle with reading, because of dyslexia or other reasons, so intervention can take place as early as possible.

"We are just beginning to understand how big this is," said Maxine B. Freund, a professor in George Washington's department of special education and the associate dean of research and external relations. "It's an opportunity we treasure."

That's especially so for students with disabilities, said Kurt W. Fischer, a Harvard professor of psychology and human development and the founder of the graduate school of education's Mind, Brain, and Education program.

"What we need to do is figure out how to harness those differences instead of making everyone learn the same way," he said.

That doesn't mean there shouldn't still be some caution about translating brain research into educational techniques, he said.

"There are people that are skeptical, and they ought to be skeptical," Mr. Fischer said. "There are lots of things happening," he added, but "it's still early."

Turning a Corner

At MIT, neuroscientist and professor John D.E. Gabrieli has been working on using brain imaging to predict which students may eventually struggle with reading. He is clear about connecting his research with the classroom.

One of his current projects involves working with about 20 Boston-area kindergarten classes in inner-city charter schools, suburban district-run schools, and Roman Catholic schools.

As many students as possible are brought to his lab for brain imaging—through the use of noninvasive functional magnetic-resonance imaging, or FMRIS—and the students get additional help based on the results.

Mr. Gabrieli will follow the students for several years to see if the targeted interventions can stave off reading problems.

"How to diagnose and classify children—the more that we can make that scientific and less arbitrary, the better," he said. "If something about the brain—the luck of the draw of their brain—is making reading extra hard for them, maybe we could just intervene early and spare them a lot of grief."

Typically, reading problems aren't diagnosed until students are in 3rd or 4th grade. Not only do reading problems at that age hamper students' ability to learn many subjects, they've lost hours of reading practice outside of school, essentially falling even further behind, Mr. Gabrieli said.

Children who enjoy reading passively hone their skills by reading for pleasure, something poor readers are less likely to do.

One research-based product that already appears to be helping some students is based on existing practices in special education.

Using BrainWare Safari, software made by Learning Enhancement Corp., based in Chicago, students play what seems like a video game for 30 to 45 minutes a day, several times a week, for three months.

The exercises build students' memory skills, their visual- and auditory-processing skills, thinking abilities, and sensory integration, said Betsy Hill, the president and chief operating officer of Learning Enhancement.


The program replicates the work of speech and language therapists, vision therapists, and psychologists, work that is tedious for both students and therapists.

Different exercises require students to click to a beat and deal with other distractions that can compete for what's known as the working memory.

Working memory allows students to do things like take notes at the same time the teacher is talking—a skill not all students easily master.

"Kids are doing one level of an exercise 100, 200, 300 times," Ms. Hill said. "You need that kind of repetition to change those neuropathways."

While students with disabilities may need to spend more time with the software for their brains to be reprogrammed, in a sense, all students have been shown to benefit, she said.

One small study in the 550-student Harbor Beach community school district in Michigan, conducted by a district speech-language pathologist without Learning Enhancement's knowledge, showed students' average improvement on cognitive tests was three years and one month in learning progress after using the program for 12 weeks, confirming results published in a scientific journal.

The district was one of the first users of the program, now in about 300 schools across the country.

Harbor Beach was so convinced of BrainWare Safari's effectiveness, it is now required for all 3rd grade students new to the district.

Speech Therapy and Autism: Behaviour and Criteria

A child going to undergo speech therapy with the diagnosis of autism has to pass a criteria of characteristics. Here are the main criteria for a child to be diagnosed.

Criteria 1: Social Interaction
The child has to have a verifiable social interaction impairment. This impairment should be manifested by at least two of following behaviours:

1.Non-verbal behaviours like quirky body posture, eye stare/gaze, facial expressions and others.
2.Failure to develop peer relationships that are appropriate for their development age like making friends or relating to other children through sheer disinterest. The lack of emotional reciprocity falls in this category.

3.Lacking the will to share emotions and thoughts. The child doesn’t usually point to objects of interest and it is up to others to read or understand what the child is interested in.

Criteria 2: Communication
The child has a communication impairment with one of the following conditions:

1.Delay or total lack of spoken language development. This includes lack of expressive language, like hand gestures and facial expressions.

2.Where the child has adequate speech, they cannot initiate a conversation or even sustain one with other people.

3.Repetitive or stereotyped use of language, commonly known as idiosyncratic language, this is where what the child keeps saying is meaningless whether the word(s) exist or not.

4.Lack of imaginative or make-believe play. Play is a major distinction for children with autism. Their play is not influenced with social signals and social adaptations from the surrounding. Since play is a major factor in language development, this is important.

Criteria 3: Repetitive And Stereotype Behaviour Patterns
Autistic children manifest repetitive behaviour, and this criteria is judged by having at least one of the following conditions.

1.An encompassing preoccupation with one or more restricted patterns of interest that seem abnormal, like focusing on a trivial object e.g. a rotating fan all day long.

2.An abnormal affection for repetitive routines and rituals. These may be normal routines with a bunch of alternatives but the child always follows the same routine and is agitated by other options or possibilities, many times to the point of throwing tantrums .

3.Repetitive body mannerisms like finger twisting or complex body postures.

4.Preoccupation with small object like screws, buttons or other miniature details.

Summary
Autistic diagonsis is standardised and the above are the criteria needed to issue a positive diagnosis.

All speech therapist that deal with autistic children require that any autistic child be properly diagnosed as autistic, before they can start speech therapy sessions.

As you may expect, these sessions tend to be even more specialised, with totally different goals and timeframes compared to sessions for non autistic toddlers.