Working with communication and swallowing problems
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Working with Communication and Swallowing Problems. Sarah Maslin Sarah Holdsworth Speech and Language Therapists Therapy assistant Conference November/December 2013. Aims and Objectives. To outline the role of the Speech and Language Therapist (SLT) in a range of settings

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Working with Communication and Swallowing Problems

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Working with Communication and Swallowing Problems

Sarah Maslin

Sarah Holdsworth

Speech and Language Therapists

Therapy assistant Conference November/December 2013


Aims and Objectives

  • 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


Myths and TruthsTrue or False?

  • 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.


What do we do?

Communication

Swallowing


What can cause some of these problems?

  • 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


Communication


Types of Communication Problems

  • 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


What do SLTs do with communication impairments?

  • 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


Communication Tips

  • 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


Swallowing

Problems with swallowing known as“dysphagia”


Definitions

What do you understand by the term?

  • Aspiration

  • Aspiration pneumonia

  • Feeding at Risk


Signs and symptoms of a swallowing problem

  • 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


How do we manage swallowing problems

  • Bedside assessment

  • Therapy

  • Diet or fluid texture modification

  • Specific postures/ manoeuvres

  • Training

  • Objective assessment

  • Non-oral nutrition/ hydration


Case study 1

  • 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 2

  • 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?


Questions


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