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The Role of the Speech & Language Therapist

The Role of the Speech & Language Therapist. Emma Burke Principal Speech & Language Therapist Bradford & Airedale tPCT Wednesday 12 th March 2008. Referrals. From? Neurologist AHP’s MND regional care advisor GP Timing? At diagnosis Needs led. Patient care. Where?

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The Role of the Speech & Language Therapist

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

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

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

  4. 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

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

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

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

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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

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

  15. 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

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

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