The Role of the Speech & The Role of the Speech & Language TherapistLanguage Therapist

Emma BurkePrincipal Speech & Language Therapist

Bradford & Airedale tPCT

Wednesday 12th March 2008

ReferralsReferrals

• From?– Neurologist– AHP’s– MND regional care advisor– GP

• Timing?– At diagnosis– Needs led

Patient carePatient care

• Where?– Home / nursing home– Hospice– Hospital

• Frequency?– Dependent on the patient, level of support, presentation

What do we do for patients?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

Communication assessmentCommunication assessment

• Dysarthria– Weakness and wasting of tongue, lips, facial muscles, pharynx and larynx– Progressive difficulty with articulation– Slurred speech– Reduced volume

• Hypernasality

Management of communicationManagement of communication

• Advise on strategies– Time– Atmosphere– Patient preference– Positioning (face to face)– Closed questions– Slow down– Over emphasise words

• Assessment and provision of communication aids

– SLT bank– Northern equipment loans MNDA– Dynavox– Funding (SLT, MNDA etc)

Communication aidsCommunication aids

• Timing

• Acceptance

• Funding

• Uses (including end of life issues)

Dysphagia assessmentDysphagia 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

• 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

Management of dysphagiaManagement 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

• 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

• 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

Non oral feedingNon oral feeding

• PEG– Patient (“giving in”)– Prolong persons ability to enjoy eating– Timing– Augmentative not alternative– Flexibility– Medication

Saliva managementSaliva 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

Team approachTeam approach

YOU ARE NOT ON YOU ARE NOT ON

YOUR OWNYOUR OWN

TALK TO THE TEAMTALK TO THE TEAM