NIHR Blog

Anna Volkmer, Speech and Language Therapist and NIHR Doctoral Research Fellow, University College London.

Using my clinical training to drive my research ideas, and my research skills to change clinical practice

Author:

Anna Volkmer, Speech and Language Therapist and NIHR Doctoral Research Fellow, University College London.

 

Date: 21 June 2017

As a speech and language therapist (SLT) I feel that most people with dementia could benefit from speech and language therapy at some point during their journey. Unfortunately the research evidence for speech and language interventions for dementia is sparse.

My particular interest is in Primary Progressive Aphasia (PPA) which is a language variant of dementia. People with PPA can present with difficulties thinking of words, or understanding words, they may mix sounds up or have difficulties with complex sentence structures. They may not present with any other difficulties in thinking or cognition for some time. Published research on interventions for people with PPA are few and far between and frequently lack rigour (and are often not designed by SLTs). The research evidence has been dominated by word relearning therapies up until now (Cartherey-Goulart et al, 2013; Jokel et al, 2014).

Word relearning therapies are where a person practises a list of words - either thinking about their sounds or meanings, on a daily basis. Now, although I was endeavouring to provide evidence-based care in my clinical practice, I felt I was using interventions outside of word relearning therapies that were not supported by the research literature. Social approaches to supporting people with communication difficulties have been shown to have a positive impact on the lives of people with post stroke aphasia yet there was no similar evidence for people with PPA. I felt that these types of approaches were extremely useful for people with PPA. This is what motivated me to apply for NIHR funding.

The first stages of my project comprised a national survey of current SLT practice in the area of PPA and a systematic review of current functional communication focused interventions. These initial stages of my research have reassured me that SLTs across the UK were using similar clinical approaches to my own; using a wide range of interventions not necessarily supported by the research literature.

I am now in the second stage of my research - refining and defining the intervention protocol for my communication training program. During the refinement process I have been using my newly acquired research skills to run consensus groups with SLTs and focus groups with people with PPA and their families. I have been on training courses to learn about qualitative research methods and have learnt to remain as objective as possible when running focus groups, yet mindful of my influence (as every qualitative researcher should be). I have learned methods of gaining a consensus opinion using Nominal Group Techniques and have been able to work with a clinical excellence network of SLTs to strategically gather their ideas about my intervention (which will be called Better Conversations with PPA). I am starting to analyse transcriptions of the focus group data using grounded theory (bottom up approaches to analysing data). Specifically thematic analysis techniques and to support me in this task I have learnt to use a piece of software called NVIVO.

As I plan the final stage of my project- an NHS based trial over three NHS sites - I am looking forward to how I will be training the local SLT collaborators and dealing with issues such as treatment fidelity and data transfer. It is only as I have developed the project that I have realised the importance of ensuring everyone delivers the exact same intervention. As SLTs we are so used to being creative with what we have; modifying an intervention to deliver it in two sessions instead of five, combining two different therapy approaches or incorporating some of the additional counselling skills we have acquired over 15 years of clinical experience. Yet I will need the SLT collaborators delivering the intervention to deliver the same thing to all the participants to enable us to do an accurate comparison.

To do this I need to record the intervention as it is delivered and collect the recordings. Making video recordings is a routine part of SLT practice. Transferring data safely to the university is a lot more complex. I have learnt so much about technology and the opportunities it can offer to manage and store data safely. Then there is the question of consent; well this is where my clinical skills are a great help again. Research feels circular, often my clinical skills underpin and strengthen my research skills, but then my research skills are enhancing my clinical skills too. What a great way to continue growing and delivering the best intervention we can for people with this type of dementia.

Follow my journey via twitter: @volkmer_anna
Or read my blog: annavolkmersbigphdadventure.wordpress.com

References:
Carthery-Goulart M T, da Silveira A D C, Machado T H, et al (2013) Nonpharmacological interventions for cognitive impairments following primary progressive aphasia. Dementia & Neuropsychologia 7(1), pp. 121-131.

Jokel R, Graham N, Rochon E, Leonard C. 2014. Word retrieval therapies in primary progressive aphasia. Aphasiology 28(8-9), pp. 1038-1068.

Volkmer, A. (2016, forthcoming) Speech and Language Therapy for Primary Progressive Aphasia: Referral patterns and barriers to service provision across the UK

Volkmer, A. (2017, forthcoming) A systematic review of functional communication interventions for people with Primary Progressive Aphasia and their families.

The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.
  • Summary:
    Anna Volkmer marks today's Chief Allied Health Professions Officer Annual Conference by writing about her research into finding speech and language interventions for dementia patients.
  • Year:
    2017
  • Author:

    Anna Volkmer, Speech and Language Therapist and NIHR Doctoral Research Fellow, University College London.