2. The Role of the Speech & Language Therapist Emma Burke Principal Speech & Language Therapist Bradford & Airedale tPCT Wednesday 12 th March 2008

3. Referrals From? – Neurologist – AHP’s – MND regional care advisor – GP Timing? – At diagnosis – Needs led

4. Patient care Where? – Home / nursing home – Hospice – Hospital Frequency? – Dependent on the patient, level of support, presentation

5. What do we do for patients? Assess (communication and dysphagia) Advise Support (patient, family, carers and other health professionals) Manage Anticipate needs Monitoring (visits and phone calls) Referral to other agencies Promote independence

6. Communication assessment Dysarthria – Weakness and wasting of tongue, lips, facial muscles, pharynx and larynx – Progressive difficulty with articulation – Slurred speech – Reduced volume Hypernasality

7. Management of communication Advise on strategies – Time – Atmosphere – Patient preference – Positioning (face to face) – Closed questions – Slow down – Over emphasise words

8. Assessment and provision of communication aids – SLT bank – Northern equipment loans MNDA – Dynavox – Funding (SLT, MNDA etc)

9. Communication aids Timing Acceptance Funding Uses (including end of life issues)

10. Dysphagia assessment Dysphagia is caused by the weakness and paralysis of the bulbar muscles Reduced lip seal Reduced tongue strength, speed and co- ordination Delayed pharyngeal swallow Reduced laryngeal elevation

11. Reduced A-P tongue movement Reduced lateral tongue movement Difficulty chewing Reduced palatal movement (nasal regurgitation) Hypersensitive gag may be present Delayed swallow reflex Reduced pharyngeal peristalsis Reduced laryngeal elevation Poor cough

12. Management of dysphagia Progression – oral stage problems > pharyngeal problems Considerations – Hydration – Calorie intake – Weight loss – Aspiration risk – Length of meals – Social aspects of eating – Enjoyment of meals – Burden of care

13. Management – Educate regarding importance of nutrition / hydration – Encourage fluids – Diet history – Change food / fluid / medication consistencies (be aware of mixed consistencies and washing food down with liquid) – Postural adjustments (feeding and saliva management) – Avoid distractions

14. Other management issues – Advice regarding swallow mechanism – Eat little and often therefore decrease fatigue – Dry clearing swallows – Swallow consciously - concentrate – Smaller mouthfuls – Monitor patients desire to eat – Swallow manoeuvres

15. Non oral feeding PEG – Patient (“giving in”) – Prolong persons ability to enjoy eating – Timing – Augmentative not alternative – Flexibility – Medication

16. Saliva management A problem with saliva transport, dehydration or both results in a thickening of secretions rather than an actual excess in salivation Postural changes Medication Suction

17. Team approach YOU ARE NOT ON YOUR OWN TALK TO THE TEAM