Speech and Language Therapy at NCH&C
Speech and Language Therapy at NCH&C
Speech and Language Therapists
Speech and language therapists (SLTs) support people affected by communication and swallowing difficulties by providing therapy, education and advice to the individual and their family.
Within specialist neurosciences we work across Beech ward (specialist stroke rehab ward), the Early Supported Discharge stroke team (providing therapy for stroke patients and supporting in the transition from hospital to home), Caroline House and Colman Hospital.
Caroline House, Colman centre for specialist rehabilitation services provides highly specialist rehabilitation for people with very complex needs following an acquired brain injury. The SLT is just one of the multidisciplinary team here working together to support these patients. Within this service we have a team of speech and language therapists who support a range of patients with both communication and swallowing needs following their acquired brain injury.
Communication difficulties may present with somebody in a disorder of consciousness, severe cognitive difficulties or speech and language impairments. The SLT will assess and provide therapy and advice for these people. Swallowing difficulties can also result from a brain injury and an SLT will assess and advise on the safest consistency for the patient to eat and drink and provide rehabilitation for swallowing difficulties.
Patients within our care may also have tracheostomies and the role of the SLT with these patients is to support both communication and swallowing, and work with the multi disciplinary team to support the removal of this.
A big part of our role is also working with families of those with acquired brain injuries to support communication with their loved one and help support them through the rehabilitation process.
Following a stroke, SLTs provide rehabilitation to target conditions such as aphasia (language difficulties), dysarthria (motor speech disorder, often resulting in slurred speech) and/or dysphagia (swallowing difficulties). SLTs can also provide support, education and advice to family or carers and support with mental capacity assessments for those with communication difficulties. We work as part of the multidisciplinary team to ensure that patient care is ‘joined up’, holistic and person-centred. We also take a keen interest in research and the recent evidence base for our practice, participating in research projects and training opportunities for our own development and to improve the service we provide.
Beech ward is a specialist stroke rehabilitation ward in Norwich. SLTs on Beech ward work with people with swallow and/or speech and language difficulties and their families.
Swallow: Almost half of people who have a stroke will experience swallowing difficulties. Often people with dysphagia may need tube feeding such as an NG tube to ensure they meet their nutritional needs. This can impact quality of life and lead to feelings of low mood and isolation. We work to assess these difficulties and determine safe eating and drinking recommendations for the person with dysphagia. Some people may need modified food/fluid e.g. a soft and bite-sized diet or thickened fluids to ensure the safety of their swallow. It is important that these recommendations are provided by a speech and language therapist to avoid risk of choking and aspiration. We also provide training to ward staff to ensure swallow recommendations are met and that patients with dysphagia are giving regular mouthcare to promote oral hygiene.
Rehabilitation to improve swallowing may involve trials of food and fluid, swallow rehab exercises, neuro-muscular electrical stimulation of swallow and biofeedback using computer programming to provide feedback on the timing and strength of swallow. We can also refer patients for a videofluoroscopy (swallow Xray) to determine areas of impairment, risk of aspiration and the safest things to eat and drink.
SLTs on Beech ward provide assessment and therapy for those with communication difficulties following a stroke. We work with the patient to establish their goals and create therapy programs and activities to target these goals. Therapy activities target understanding, speaking, reading and writing. We also create and review therapy programs for our assistant practitioners to complete with patients.
Communication difficulties can often result in feelings of isolation and depression and so a key part of our role is working with the MDT (including psychology) to monitor mood and support patients and families through these feelings. We may also provide training such as the ‘Better Conversations for aphasia’ program to support people with aphasia and their loved ones to have conversations together.
We work closely with the MDT and participate in regular MDT meetings and joint working e.g. working with occupational therapy to complete therapy in the kitchen such as making a cup of tea or a sandwich. An important part of the SLT role is also supporting with mental capacity assessments for those with communication difficulties, including discussions around power of attorney applications.
Early Supported Discharge Stroke (ESD) team
Within the ESD team, SLTs can provide up to six weeks of therapy for people with communication or swallowing difficulties after their stroke.
This therapy is tailored to the patient and we work closely with patients and their families to set appropriate goals for therapy that are most important to the patient. This may include returning to work, hobbies or day to day activities. Previous therapy activities have included practicing saying commands to dogs, ordering fish and chips from the local takeaway, being able to take minutes for work meetings, singing hymns, reading headlines in a newspaper, telling jokes and improving speech clarity to be understood on the telephone.
We also work closely with family and friends to provide support and education regarding communication and swallow difficulties and signpost to local support services. We provide strategies and recommendations for how best to communicate with the individual, or how to ensure that food/fluid is prepared to ensure safe swallowing.
We work closely with the multidisciplinary team and ensure that all therapists are working towards the same goals and the team has advice on how best to communicate with our patients. We also create programs of therapy activities which the rehabilitation assistants in ESD complete with patients, aiming to provide a similar intensity to therapy as was received in hospital.