SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 201114

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The broad or narrow way? Can you remember the symbol for a voiced palatal fricative, or the diacritic for no audible release? Does it even matter? Having carried out a survey of phonetic transcription practice among student speech and language therapists to probe their use of broad and narrow techniques on clinical placement, Fay Windsor discusses the implications of a possible gap between theory and practice.

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THE THEORY-PRACTICE GAP

• REDISCOVER LOST SKILLS

• CAPTURE GRADUAL CHANGE

As a speech and language therapist involved in teaching phonetics to speech and language therapy students,

I have often reflected on my own clinical experience and related transcription practice. My clinical experience has been gained mainly from working with children in community clinics and mainstream schools, and my related transcription practice has been almost entirely broad or impressionistic in nature.

Knowing that narrow transcription is often held up as the gold standard (Howard & Heselwood, 2002; Louko & Edwards, 2001), it makes me feel rather uncomfortable to admit to my clinical reliance on broad transcription. Unsurprisingly, I have often found myself asking the question: if broad, impressionistic transcription is the norm in clinical practice, why do we persevere in the learning and teaching of narrow phonetic transcription skills? After all, phonetic transcription, whether broad or narrow, is a skill which quickly deteriorates if not used.

These issues encouraged me to undertake a fact-finding study investigating the type of phonetic transcription used on clinical placement by students from Manchester Metropolitan University where I am a lecturer. I first explored what the literature has to say on the subject.

Speech and language therapists use phonetic transcription to describe their clients’ speech production as part of assessment, to inform intervention and to document change. It is considered a basic clinical skill (Powell, 2001) and, in the UK, it is recommended that pre-registration training in phonetics should include production and transcription of all the sounds represented by the International Phonetic Alphabet (IPA, 2005a) and the extIPA Symbols for Disordered Speech (IPA, 2005b), together with analysis of prosody and voice quality (RCSLT, 2010). Post-registration, depending on the client group we work with, phonetic transcription may be more or less relevant, or possibly not relevant at all.

In terms of everyday practice, it is unclear to what extent speech and language therapists actually make use of narrow transcription. Presumably our transcription practice will be influenced by the purpose

of our assessment, the types of assessment we use, and the nature and severity of our clients’ communication difficulties. While to a certain extent it will also be influenced by the type of training we have received, my own experience demonstrates that being trained in narrow transcription does not guarantee it will actually be used.

The literature suggests that, in some cases, broad transcription is acceptable: “if there are just a few sound errors … it may not be necessary to use diacritics” (Louko & Edwards, 2001, p.3). Dodd et al. (2002) go further, recommending that “In most cases a broad transcription system (i.e. without phonetic detail) will be sufficient” (p.14). There is also evidence to suggest that broad phonetic transcriptions may actually feature more frequently than narrow transcription in some aspects of the research literature, for example, on phonological development (Hewlett & Waters, 2004).

Value highlightedMore recently, however, a small number of articles have highlighted the value of narrow transcription. For example, Ball et al. (2009a;

2009b) stress the importance of narrow transcription, not only for highly unintelligible speech, but also in relation to the growing linguistic diversity of our clients whose spoken output may reflect the influence of languages other than English. In addition, and notwithstanding the problems of reliability and validity connected with the different types of transcription, Hewlett & Waters (2004) provide evidence, including data from The Edinburgh Articulation Test (Anthony et al., 1971), to show how children’s mastery of the articulatory targets required to signal phonological contrasts proceeds in a gradual as opposed to an all-or-nothing fashion. Whereas narrow transcription can capture these ‘gradient’ changes in pronunciation over time, broad transcription encourages the erroneous idea that children make a sudden jump from one phoneme category to another (Hewlett & Waters, 2004).

Day-to-dayAlthough there is some support for the utility of narrow phonetic transcription, I have a hunch that, on a day-to-day basis, the transcription style of speech and language therapists is probably more broad than narrow. If so, and if training in narrow transcription has been received, the disparity between what is taught and what is practised would represent what is known as a ‘theory-practice gap’. Such gaps have been identified within other vocational subject areas such as nursing, and attributed in a practice setting to pressure on time, staff shortages and the influence of poor role models (Maben et al., 2006). In addition, a mismatch between the situations in which knowledge is acquired and applied has been highlighted (Swain et al., 2003).

The aim of my study was to explore a possible gap between theory and practice in speech and language therapy. I wanted to find out what type of phonetic transcription is used on clinical placement by students, with a view to investigating the issue more widely in the future.

Having first obtained the necessary ethical approval, I designed and piloted a short online survey comprising seven questions covering clinical placement experience, opportunities

Fay

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15SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2011

for using phonetic transcription and, more specifically, opportunities for using narrow and / or broad transcription. An optional question allowed participants to express an interest in being interviewed about their experiences of using phonetic transcription on clinical placement. Where appropriate, a Likert scale ranging from 1 = ‘always’ to 6 = ‘never’ was incorporated. Speech and language therapy students at Manchester Metropolitan University in Years 3 and 4 (n = 89) were then invited to complete the survey. Fifty students participated. The first four students to express an interest in being interviewed subsequently took part in a semi-structured interview in two pairs.

Figure 1 shows the majority of respondents had ‘sometimes’ (46 per cent) or ‘fairly often’ (32 per cent) had some sort of opportunity to use phonetic transcription on clinical placement. A small percentage (12 per cent) indicated that they had ‘almost never’ had any opportunities but no students indicated that they ‘never’ had.

Regarding type of transcription, most students indicated that they had ‘sometimes’ (44 per cent) or ‘fairly often’ (22 per cent) had opportunities to use broad transcription, whereas most had ‘never’ (36 per cent) or ‘almost never’ (32 per cent) had opportunities to use narrow transcription. Just over a quarter of participants (26 per cent) indicated they had ‘sometimes’ had the opportunity to use narrow transcription.

I analysed transcripts of the interviews for themes relating to the students’ experiences of using phonetic transcription on clinical placement. Those that emerged included:

• type of placement• role models• level of skill• utility of narrow transcription.The students were clear that, overall, their

paediatric placements had offered more opportunities for using phonetic transcription. Within paediatrics, they gave examples of particular client groups (cleft lip and palate and hearing impairment) where narrow transcription had sometimes been used.

Role modelsIn terms of role models, the students rarely observed their clinical educators using narrow transcription, and the educators were sometimes perceived as delegating transcription tasks to students on the basis that the student’s skills were likely to be better than their own: “I just haven’t seen narrow being used at all”; “Therapist told me she wasn’t confident”. Tied to this, and in relation to their own competence, students were acutely aware that any sort of transcription requires repeated practice: “I see it as a skill and unless you use it frequently …”.

Regarding the overall utility of narrow transcription, the discussion suggested that students felt better able to attend to speech and that narrow transcription had allowed

them to make more sense of broad transcription: “I think it’s made me listen a bit more to the finer detail, tuned me in a little bit more”. However, pressure of time was an issue around using narrow transcription in day-to-day practice and there was a sense that broad transcription did the job, allowing you to record essential information and plan intervention without the problems of transcription reliability: “Bit of a rush in community clinic”; “Narrow lot less consistent”. Related to this was a feeling that narrow transcription was more of an academic activity: “General opinion is you’ve used that [narrow transcription] in uni but you never use it [outside]”.

Finally, the students were not sure if using narrow transcription in practice would make a difference, especially in terms of type of intervention. They suggested that more evidence was needed: “If you’d done a broad transcription [only] this is what you’d have missed”.

Despite small numbers of participants, my study provides tentative support for a theory-practice gap in speech and language therapy between phonetic transcription as taught and practised. The implications of this potential gap include issues around training opportunities and the availability, within a service, of specialist speech and language therapists to support colleagues working with children and adults. The fragile evidence base surrounding the utility of narrow transcription in day-to-day clinical practice is also highlighted and, at the same time, questions are raised about the way in which simply learning to do narrow transcription impacts on the way we interpret our clients’ speech.

Interestingly, two clinical assessments which encouraged in-depth assessment of children’s phonetic and phonological capabilities are now out of print (see Anthony

et al., 1971; Grunwell, 1985). This leads me to wonder whether there is a parallel here with what Nunes (2011) described as the current “overemphasis by speech and language

therapy as a profession on confidence and communication at the expense of diagnosis and therapy” (p.11). Either way, the good news is that gaps between theory and practice are not a bad thing. On the contrary, Haigh (2009) argues that ‘gaps’ within professions should be celebrated since, without them, there is little impetus for growth.

Fay Windsor is a senior lecturer in speech pathology and therapy at Manchester Metropolitan University. She hopes readers will continue the transcription debate and get in touch with their comments, email f.windsor@mmu.ac.uk.

ReferencesAnthony, A., Bogle, D., Ingram, T.T.S. & McIsaac, M.W. (1971) The Edinburgh Articulation Test. Edinburgh: Churchill Livingstone.Ball, M., Muller, N., Klopfenstein, M. & Rutter, B. (2009a) ‘The importance of narrow phonetic transcription for highly unintelligible speech: some examples’, Logopedics Phoniatrics Vocology 34(2), pp.84-90.Ball, M.J., Muller, N., Rutter, B. & Klopfenstein, M. (2009b) ‘My client is using non-English sounds! A tutorial in advanced phonetic transcription part 1: consonants’, Contemporary Issues in Communication Science & Disorders 36, pp.133-41.Dodd, B., Hua, Z., Crosbie, S., Holm, A. & Ozanne, A. (2002) Manual of Diagnostic Evaluation of Articulation and Phonology. London: Harcourt Assessment.

Figure 1 Percentage of students surveyed who had the opportunity to carry out phonetic transcription on clinical placement

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the good news is that ....‘gaps’ within professions

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In Brief...supported byGrunwell, P. (1985) Phonological Assessment of

Child Speech (PACS). Windsor: NFER-Nelson.Haigh, C. (2009) ‘Editorial: Embracing the theory/practice gap’, Journal of Clinical Nursing 18(1), pp.1-2.Hewlett, N. & Waters, D. (2004) ‘Gradient change in the acquisition of phonology’, Clinical Linguistics & Phonetics 18, pp.523-533.Howard, S.J. & Heselwood, B.C. (2002) ‘Learning and teaching phonetic transcription for clinical purposes’, Clinical Linguistics & Phonetics 16(5), pp.371-401.International Phonetic Association (2005a) The International Phonetic Alphabet (Revised to 2005). Available at: http://www.langsci.ucl.ac.uk/ipa/ (Accessed: 11 August 2011). International Phonetic Association (2005b) extIPA Symbols for Disordered Speech (Revised to 2002). Available at: http://www.langsci.ucl.ac.uk/ipa/ (Accessed: 11 August 2011). Louko, L.J. & Edwards, M.L. (2001) ‘Issues in collecting and transcribing speech samples’, Topics in Language Disorders 21(4), pp.1-11.Maben, J., Latter, S. & Clark, J.M. (2006) ‘The theory-practice gap: impact of professional-bureaucratic work conflict on newly-qualified nurses’, Journal of Advanced Nursing 55(4), pp.465-477.Nunes, A. (2011) ‘A question of scale’, Bulletin of the Royal College of Speech & Language Therapists September, p.11.Powell, T.W. (2001) ‘Phonetic transcription of disordered speech’, Topics in Language Disorders 21(4), pp.52-72.RCSLT (2010) Guidelines for Pre-Registration Speech and Language Therapy Courses in the UK (Incorporating Curriculum Guidelines). Available at: http://www.rcslt.org/about/work_with_educators/curriculum_guidelines (Accessed 11 August 2011).Swain, J., Pufahl, E. & Williamson, G.R. (2003) ‘Do they practise what we teach? A survey of manual handling practice amongst student nurses’, Journal of Clinical Nursing 12(2), pp.297-306.

Research centre on the webWendy Best, Suzanne Beeke, Caroline Newton & Rachel Rees invite you to make use of the Centre for Speech and Language Intervention Research website for event information, making new contacts and accessing evidence based resources.

Have you heard of the Centre for Speech and Language Intervention Research? We would like to give you an overview

so you can see why it and its website may be of interest to speech and language therapists and their colleagues.

The Centre is based in University College London’s Division of Psychology and Language Sciences. It focuses on research in speech and language disorders, with an emphasis on intervention and practical implementation. Members come from the UK and abroad, work in health and education settings, and their interests span developmental and acquired communication difficulties.

The aims of the Centre are to:• foster collaborative health service related

research in the field of speech and language pathology and intervention

• disseminate current research information and encourage implementation in clinical practice

• foster partnerships in order to build research capacity across speech and language therapy centres

• be a resource for practitioners by providing access to web-based materials for use in assessment and therapy.

We achieve these aims through holding regular events, disseminating research and resources via our website and through joint Higher Education Institution / National Health Service research projects. Our Doctoral students also have their projects linked to the Centre.

• Perhaps you or a colleague could come to a Centre event?

Apraxia of speech diagnosis: opening the can of wormsJon Hunt argues that we need to be clearer in differential diagnosis of phonological and articulatory difficulties underlying what we refer to as apraxia of speech.

When we describe someone as having ‘apraxia of speech’, what are we effectively saying?

Most speech and language therapists would agree that in issuing this diagnosis we are claiming that the person in question has a difficulty with ‘motor programming’, that is the ability to place the articulators in such a way as to represent the intended sound sequences. In other words we are claiming that the person is demonstrating a discrepancy between the sound of the word in their head, and what comes out of their mouth. In psycholinguistic terms, we are claiming that there is a discrepancy between phonological output and articulatory output.

Making this claim implies that we have evidence that the person has the sound of the word(s) correctly represented in their head – or at least more correctly than the spoken output would suggest.

At present in speech and language therapy we tend not to make any effort to substantiate such claims. We base our apraxia of speech diagnoses on overt speech behaviours such as sound mis-selection and ‘groping’, and on awareness of errors. These criteria were initially proposed in the 1970s by Frederic Darley and his colleagues, who arrived at their symptoms of apraxia of speech by taking patients whom they believed to have it and then describing their symptoms, an approach which McNeil et al. (1997) call ‘experimental tautology’.

McNeil et al. argue that the vast majority of Darley’s proposed (and still widely used) diagnostic criteria are invalid, since they are at least as likely to reflect phonological difficulties as articulatory ones. Darley and his colleagues stated that most if not all their subjects had aphasia as well as (allegedly) apraxia of speech. So how did they know which symptoms were due to which disorder?

How can we tell if the underlying phonology really is intact? One way is to look at the effects of cueing. If the person is helped by cues which give no articulatory information, such as semantic, phonemic (unseen), closure or orthographic cues, then this points to a phonological instability. And if the person is an adult with good cognitive skills, try showing them pairs of pictures of objects which have names that either rhyme or don’t rhyme. If they can judge which pairs rhyme but can’t realise those distinctions in spoken output,

this suggests a discrepancy. If they can’t, this could again point to a phonological problem. Similarly with syllable number judgement.

Does it matter if we get it wrong? Is artic-ulatory therapy necessarily invalid if a problem is more phonological? Well, that’s another debate, but at least it’s good to be as clear as we can be about what we’re dealing with.

Jon Hunt is a speech and language therapist with North Bristol NHS Trust.ReferencesDarley, F.L., Aronson, A.E. & Brown, J.R. (1975) Motor Speech Disorders. Philadelphia: Saunders.McNeil, M.R., Robin, D.A. & Schmidt, R.A. (1997) ‘Apraxia of speech: Definition, differentiation, and treatment’, in M.R. McNeil (Ed.) Clinical management of sensorimotor speech disorders. New York: Thieme (pp.311-344).

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REFLECTIONS• DO I PROVIDE A GOOD ROLE

MODEL FOR STUDENTS ON CLINICAL PLACEMENT?

• DO I DRAW ON THE SPECIALIST KNOWLEDGE OF COLLEAGUES WHEN APPROPRIATE?

• DO I USE ANY TEACHING MOMENTS TO THINK ABOUT MY OWN PRACTICE?