Working with Communication and

Swallowing ProblemsSarah Maslin

Sarah HoldsworthSpeech 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

Aims and Objectives

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.

Myths and TruthsTrue or False?

Communication

Swallowing

What do we do?

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

What can cause some of these problems?

Communication

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

Types of Communication Problems

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

What do SLTs do with communication impairments?

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

Communication Tips

Problems with swallowing known as“dysphagia”

Swallowing

What do you understand by the term?

Aspiration Aspiration pneumonia Feeding at Risk

Definitions

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

Signs and symptoms of a swallowing problem

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

How do we manage swallowing problems

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?

Case study 1

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?

Case study 2

Questions