Adults

Offering Speech and Language Therapy to adults who have the following acquired difficulties:

Dysphagia = difficulty swallowing

 

 

 

 

 

 

Potential Causes:

  • Stroke - Research suggests that up to 60% of people experience some form of dysphagia following a stroke.

  • Traumatic Brain Injury 

  • Progressive neurological diseases, e.g. Parkinson's Disease, Motor Neuron Disease, Huntington's

  • Head and Neck Cancer treatment - radiotherapy or surgical resection

  • Immune disorders 

  • Medical decompensation - e.g. respiratory compromise 

 

Cognitive-behavioural difficulties may contribute to eating and drinking difficulties in the advancing stages of dementia

 

Signs and Symptoms:

  • Persistent or regular coughing when eating or drinking

  • Episodes of choking

  • Recurrent chest infections (Aspiration Pneumonia)

  • Difficulty or discomfort when swallowing

  • Difficulty chewing or clearing food from the mouth and throat

  • Food avoidance or loss of interest in eating

  • Weight loss

  • Dehydration

How Can a Speech & Language Therapist Help?

DIAGNOSIS

  • Obtain a history of the presenting condition and contributing factors  

  • Conduct a clinical assessment of swallowing function by examining what happens when you eat or drink.  

  • Provide a detailed report outlinig diagnosis, treatment plan and approach to management

SUPPORT

  • Provide an individualised Treatment Plan regarding diet or fluid modifications - making changes to what you eat or drink to promote safer or easier oral intake

  • Provide strategies to compensate for swallowing difficulty and promote optimal intake

  • Introduce exercises to improve swallow function

MANAGEMENT

  • Provide a care plan for management of dysphagia and eating & drinking difficulties - e.g. for people in Nursing Homes or those dependent on others for their care

  • Monitor condition in order to manage change 

  • Manage transitions - e.g moving from hospital to home 

  • Make appropriate onward referrals

  • Work together with your GP, specialist or Dietitian to manage nutrition and hydration

  • Navigate the challenges of end of life care - managing risk and maintaining comfort 

  • Education and training of others (family, carers, nurses, etc) to ensure consistent care

 
 
 
 

Communication Impairments

Communication is a complex and multifacetted process 'by which information is exchanged between individuals through a common system of symbols, signs, or behavior' (As defined by Merriman-Webster).

A breakdown in or barrier to communication can occur as a result of an individual experiencing difficulties with their speech, voice, language, sensory faculties (sight, hearing) , cognitition or their understanding and application of pragmatics.

Speech & Language Therapy seeks to diagnose and profile communication difficulties and in doing so provide an individualised plan for support, rehabilitation and eductation.

Causes of Acquired Communication Difficulties

  • Ischaemic or haemorrhagic stroke 

  • Traumatic Brain Injury

  • Brain Tumours

  • Hypoxia

  • Vocal fold pathology 

  • Head, neck or lung cancer and treatment thereof

  • Neurodegenrative Diseases - Motor Neurone Disease, Parkinson's Disease, dementia, Primary Progressive Aphasia

Aphasia (also referred to as dysphasia) is an acquired disorder of language which can affect auditory comprehension, oral expression, reading, writing, and word finding.  

Aphasia occurs as a result of damage (stroke, brain injury, atrophy) to language centres of the brain, usually located in the left cerebral hemisphere.

Broadly speaking, aphasia can be categorised into Receptive (also referred to as fluent or Wernicke's aphasia) or Expressive (also referred to as non-fluent or Broca's aphasia) Aphasia.  Aphasia manifests in a variety of ways with varied levels of severity.

 

Speech & Language Therapists provide specialist assessment, treatment and support along the recovery pathway - be it during the very acute stages where education, strategies and advice are required, during the sub-acute phases where rehabilitation potential is harnessed or in the more chronic phases of recovery where functional goals and reintegration remain a focus of treatment    

VERBAL Apraxia

Caused by neurological damage secondary to  stroke, brain injury, etc, Apraxia is an impairment of motor programming and planning.  Messages from the brain to the mouth are disrupted which results in difficulty with voluntarily producing speech even though the muscles are not weak and there is no difficulty with language (NOTE: verbal apraxia can co-exist with aphasia or dysarthria).

Slurred speech due to weakness of the tongue, lips and other oral structures used for speech.  Features of dysarthria may also include changes to the volume, pitch or speed of speech.  Speech may have a nasal quality or the voice may change.

Dysarthria can occur as a result of a stroke or brain injury and is often associated with progressive neurological conditions, including Parkinson's Disease, Motor Neurone Disease, etc.

It is important to seek advice from a Neurologist or Speech & Language Therapist if you notice speech changes.

Cognitive impairments of attention, memory, perception, organisation, etc can impact how people interact and communicate.  These difficulties can occur as a result of traumatic brain injury, cerebral infections or damage to the right hemisphere or frontal lobes of the brain.  

Cognitive-communication impairments can be more subtle to identify than communication impairments such as aphasia and dysarthria, characteristic features may include:

  • Verbosity - excessive verbal output

  • Tangential conversation - going off topic

  • Slow processing

  • Inappropriate topics/content/style of conversation

  • Reduced initiation of conversation

  • Passive interaction

These features can have a significant impact on the success of conversations and relationships.  It is important that they are identified and addressed - Speech & Language Therapists are specialists in providing education and advice in managing cognitive-communication difficulties

dysarthria

 
 
 
 
 
 

Sarah Bean

BSc Speech-Language Pathology

(UCT)

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Cape Town

South Africa

Tel: 081 311 3666

Email: sarahbeansalt@gmail.com