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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?
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?
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
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
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