Stroke Symposium October 2023 PDF

The Role of the Speech and Language Therapist in Acute Stroke Lynsey Keeley – Speech and Language Therapist Case presentation aims Understand initial SLT management sw/comm Be aware of swallow management/progress Be aware of communication input/considerations Understand MDT working Think about you...

The Role of the Speech and Language Therapist in Acute Stroke Lynsey Keeley – Speech and Language Therapist Case presentation aims Understand initial SLT management sw/comm Be aware of swallow management/progress Be aware of communication input/considerations Understand MDT working Think about your role as Dr Be aware of discharge planning Acute Stroke patient 61 yr old male admitted found on floor with “garbled speech” right sided weakness, sensory loss, right facial droop, L gaze palsy and hemianopia Past medical history – hypothyroidism, COPD Social history – smoker 30-40 per day/50 years, excess alcohol, self neglect, lives alone Referred to SALT for swallow and communication assessment Initial SLT considerations/Ax Failed level 1 swallow screen and NBM SALT AX – CN V, VII, XII impaired, moderate dysphagia, aspiration risk high. ½ tsp of water, NG tube, mouthcare Communication – tearful, distressed, diff to formally ax, pointing, gestures, occ verbal response, strategies to help Severe expressive and receptive dysphasia, verbal apraxia Communication • Aphasia / dysphasia – language disorder, affects one or more of: speaking, auditory comprehension, reading and writing • Dysarthria – motor speech disorder due to muscle weakness or incoordination • Apraxia of speech – motor speech disorder due impaired motor planning for speech • Dysphonia – voice disorder • Cognitive communication disorder – difficulties with communication due to complex interplay of cognitive deficits, often noticeable in changes in social communication Bed Toilet Chair Hungry Thirsty Wet towel You Tube video Aphasia - what a difference some help makes - Training video by www.florentia.co.uk for D yscover - YouTube How to communicate more effectively • If pre-existing communication difficulty – find out about it and how the patient normally communicates • If the patient has difficulty understanding you try to: • Keep information short and simple • Emphasise the key words • Use objects, gesture, pictures or write down key words • If the patient is having difficult communicating you could try: • Giving them extra time (do not repeat multiple times) • Encouraging them to write or draw • Asking closed questions e.g. yes/no questions • Considering all forms of communication e.g. non-verbal, gesture • Don’t be afraid to say to a patient you cannot understand them. Progress Increasingly agitated on the ward, wanting to leave, poor engagement with therapy Formal capacity ax carried out – SLT and Neuro Psychology. U/a to demonstrate capacity or understand the risks of leaving. DOLS. Ongoing unclear bedside ax of swallow, pt removed NG, after capacity ax agreed for re insertion. U/a to start on oral intake Aiding discharge Swallow – aim to inc textures to manage at home, u/g to minced moist diet. Pt expressed he would eat all foods – poor insight. Comm – problem solving and inc awareness of risks, work on very useful goals – buying lottery ticket, paying bills in post office, greetings, topping up mobile phone, Say Aphasia vols – to intro comm support Further cap ax – best interest decision to go home. Ref to ESD (Early Supported Discharge Team) Friends? Family? Interesting facts about me Hello! My name is. Likes e.g. food, drinks, hobbies, music etc? Please use this chat mat to talk to me about things I am interested in. . Goals I would like to achieve: - I would like to be able to do my ironing and washing for myself - I would like to make myself bacon and eggs for lunch - I would like to walk or get the bus to the pub to have a chat over a drink Phrases to practice my speech: Thank you Tea please How are you? I need more clothes I need the toilet I want to speak to Beth Len Considerations Initial presentation and how unwell he was Impact of this on his engagement and decision making The need for non oral feeding and objective ax in acute stroke Initial capacity ax and DOLS Progress made throughout admission- spontaneous and therapy MDT working and joint capacity ax Getting to know the patient – self neglect, loner, pub, lifestyle Community support set up prior to discharge – Say Aphasia Volunteers ESD service in Brighton Time ++ for patient recovery, respecting his wishes – patient centred care Thank you for listening and any questions …