Sarah Maslin Sarah Holdsworth Speech and Language Therapists Therapy assistant Conference November/December 2013

 To outline the role of the Speech and Language Therapist (SLT) in a range of settings  To discuss communication and swallowing problems  To think about how you as Therapy Assistants can help when working with these patients

 Everyone with a swallowing problem should have thickener in their drinks  Only Doctors/nurses can refer to SLT  If someone can’t speak they won’t understand what I am saying  SLT can advise around communication support strategies (visual charts, gesture)for patients  Patients having difficulty with medication, The SLT needs to assess their swallowing.

Communication Swallowing

 CVA  Parkinson’s Disease  Motor Neurone Disease  Multiple Sclerosis  Huntingdon’s Chorea  Myasthenia Gravis  Head Injury  Brain Tumour  Dementia  Head and neck cancer  Tracheostomy/intubation  Developmental / congenital conditions

 Dysphasia (or aphasia): difficulty understanding or producing language (words, sentences, conversation), which may include reading and writing  Dysarthria difficulty producing clear speech, “slurred” speech, due to muscle weakness  Dyspraxia difficulty planning how to pronounce words (can also affect planning other types of movements)  Dysfluency stammering / stuttering Types of Communication Problems  Dysphonia difficulty producing adequate voice, from hoarse voice to total loss of voice

 Assess and diagnose communication impairments  Direct work with clients  Work with communication partners  Compensatory strategies  Support or confidence building in specific situations  Communication support for specific discussions or decision making

 Glasses and hearing aids  Give your full attention  Sit or stand at the same level as the person  Give eye contact  Speak slowly and use simple language  Ask yes/ no questions  Give additional time for communication  Reduce distractions and background noise as possible  Make use of gestures, facial expression, writing and pictures to support your communication  Understand the specific difficulty – speak to the SLT

Problems with swallowing known as“dysphagia”

What do you understand by the term?  Aspiration  Aspiration pneumonia  Feeding at Risk

 Coughing whilst eating and drinking  A ‘wet’ or gurgly voice after swallowing  Shortness of breath after eating and drinking  Choking, red face and watering eyes  Food or drink coming down the nose  Pain or discomfort on swallowing  Difficulties chewing  Excessive drooling  Difficulties clearing the mouth of all food after a meal

 Bedside assessment  Therapy  Diet or fluid texture modification  Specific postures/ manoeuvres  Training  Objective assessment  Non-oral nutrition/ hydration

 John, aged 70, in hospital following CVA  Expressive and receptive dysphasia  John can produce single words if given time to respond and he often makes mistakes e.g. says “bath” when means “bed”  SLT have provided a communication chart – John can correctly point to pictures of what he wants / needs  Can understand simple phrases but not long complex sentences  Think about how you would facilitate this patients communication in one of your sessions?

 Claire, 40 Attending MDH for OT and Physio,  Recently discharged from hospital following CVA  Patient complaining of poor saliva management and you notice when drinking in sessions patient clearing her throat.  Patient feels generally well in herself  How would you manage this?