Cognitive Therapy Group at Northern Ireland Social Services Day Centre for people with sensory and physical impairment.

I have been a volunteer group facilitator here for thirty years. Originally a creative drama group, over the years it has segued into an hour long, weekly, Cognitive Therapy Group. The aim is individual stimulation and social interaction. Individual stimulation includes personal confidence building, physical activity, vocalisation, physical activity, communication, thinking, reflecting, imagining and remembering.

Group Composition. Eight members and a support worker. All but one have some kind of head injury. Two have no speech, and are severely physically disabled. Most are in their thirties or forties. One elderly member has a learning difficulty.

After an introductory chat during which each person is invited to share a piece of news, we usually have voice work. For years I have been developing the possibilities within one particular exercise:
Ah-bah, Ee-bah, Eye-bah, Oh-bah, You-bah.
ie. Aba, Eba, Iba, Oba, Uba.
And then Aca, Eca,, Ica,Oca, Uca…….Aba, Eba, Iba, Oba, Uba, ….and so on. One set of vowels for each letter of the alphabet.
After I have spoken a phrase aloud the participants copy .
Each person in the group connects with this exercise in a different way : i.e.
For some people I say one of the alphabet phrases quite rapidly , eg. “Aba Eba Iba Oba Uba,” and they repeat it back, at the same speed; then we move on the next letter and so on through the alphabet.
With other people I work slowly – pausing for a long time between each syllable, articulating it with care; and waiting patiently for the person to make their response.
The people who cannot speak, may mouth the syllables with their lips; and some occasionally make vocal sounds. This is often a very moving moment.
Each week I ask everyone to think of a word for a particular letter of the alphabet – usually a word beginning with that letter, though a word containing the letter within it is acceptable. They then call out their words. Anyone with no speech spells out their word on their voice machine. Some results are surprising. For the letter “P” , Nora ( not her real name) typed P first, then S. I thought that she had made a mistake. She persisted, and typed “psoriasis”!
Brian always impresses with long words, Some invented by himself. For example: cateoricalistically, zanzabarion zezogaphone, and beezambastickillasstically.
Through the week I work on creating a tongue twister of all the words of that day, and add a drawing. These are kept in a notebook , photocopied for everyone when it is finished, the original being raffled.
The new tongue twister is practiced with the group the following week.
Eg. Leslie and Léann laughed long when the loser’s lover lit up the languostine with a lighter” ( Brian had been a chef).

Physical Exercises
A few of the group take turns at leading us in doing actions of their choice. This requires detailed observation on all our parts. Some of the more severely impaired members who also have very limited vocalisation are most insptational.
One or two people then sing for us. In spite of their fractured voices, we can hear in our minds the original melody and the former tunefulness of the voices – although the feeling put into the singing has its own special eloquence.

More speech exercises follow. Eg. Tongue twisters, and children’s rhymes. These latter are also nostalgic and provide material for reminiscence.
Speech exercises are readily available on the internet. I also include a few basic singing techniques. Eg. Exercises which exercise facial, mouth and tongue muscles. Eg. 1) Mah , May, me, mo moo, chanted slowly on the same note, encouraging wide smiles at “me” and strongly pointed lips at “ moo”,

1. Lip Buzz. Blowing out through loosely pursed lips and adding pitch.
2. For the jaw. Move a slackened jaw from side to side, and then pushing the chin forward and back.
3. For the tongue. “Lah lay lah low” , with mouth hanging loose and not using the lips.
4. One of my favourites is singing the words “sing song, sing song” to tunes of choice.

Another feature of the session is my reading stories and poems. I have recently been using, Madeline Mc Cully’s “ Haunted Derry”. ( NB. I also use this with a group of older adults with learning difficulties. ) With the groups I read a few sentences and then check back to see who can remember some of the facts eg. People’s names, and place names. The groups also provide sound effects as appropriate. Screams are particularly enjoyable.
For poetry I use popular traditional poetry such as The Nation’s Favourite Poems (BBC), leading to shared associations and discussions. I like to include poetry which might be a bit difficult, but which has beauty of sound and imagery, eg. WB Yeats’ Cloths of Heaven. I recently read Coleridge’s Kubla Kahn to the adults with learning difficulties, receiving a very positive response. I had mentioned that the poem came out of a kind of dream state, and invited the participants to close their eyes and enjoy the dream, which some of them did.
If this seems a lot for an hour’s session it is because we don’t always attempt everything in every session.

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Contributors: James King
Sectors: Disability,Voluntary sector
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