Speech and Language Therapy. Kerrie McCarthy Senior Speech and Language Therapist

Transcription

1 Speech and Language Therapy Kerrie McCarthy Senior Speech and Language Therapist

2 Contents 1. Voice disorders 2. Swallow disorders 3. Videofluroscopy 4. Adult Acquired Communication Disorders 5. How to refer

3 Voice disorders Many people rely on their voice and ability to communicate to carry out their job May require time out of work until voice improves Social disadvantage May have discomfort, fatigue or pain associated with speaking Dealing with Dysphonia. A luxury or a necessity? Produced by the British Voice Association

4 Voice disorders (dysphonia) Dysphonia occurs when the vibration of the vocal cords becomes disrupted by damage, lesions, swelling, malignancy or voice misuse/ abuse Dysphonia often co-occurs with other medical conditions such as respiratory conditions, neurological conditions, musculo-skeletal problems & digestive disorders

5 Voice disorders (Dysphonia) Dysphonia that does not improve within 3 weeks should be referred to ENT Following ENT examination of larynx referral to speech and language therapy if appropriate

6 Voice presentation Hoarseness Breathiness Weak voice Decreased pitch range A lump in the throat sensation Vocal fatigue Pain or aching associated with voicing

7 Voice Disorders Vocal cord nodules Vocal cord bowing Vocal cord paralysis Muscle Tension Disorder

8 Voice LAX VOX Direct therapy techniques Laryngeal manual therapy Lee Silverman Voice Therapy Vocal function exercises Vocal hygiene Indirect therapy techniques Breath support Relaxation

9 Drooling Difficulty managing solid foods Complaints of food sticking in the throat Wet sounding voice Coughing during or after eating/drinking Extra time for meals Swallow (Dysphagia) Detailed case history Oromotor assessment Swallow assessment on oral intake Appropriate food/ fluid recommendations Safe swallow guidelines & education Swallow rehabilitation Consideration for videofluoroscopy

10 Videofluoroscopy Considered the gold standard for objective swallow assessment Only private videofluoroscopy service nationally A new fluoroscopy suite was installed in 2016 with state of the art equipment Better quality images Able to accommodate patients with mobility needs/ in specialised seating

11 When to refer? To assess anatomy and physiology of swallow Coughing and/or choking while eating & drinking Food sticking in the throat Recurrent chest infections/ pneumonia Differential diagnosis of dysphagia e.g. neurological vs structural Masses on the tongue, pharynx or larynx Muscle weakness involving the pharynx Neurologic disorders likely to affect swallowing

12 Videofluoroscopy Results are sent out within 48 hours If a swallow disorder in identified, outpatient SLT can provide a swallow management plan & follow-up guidance & support on any food/fluid modification compensatory strategies that may help their swallow rehabilitation exercises to strengthen the swallow

13 Videofluoroscopy

14 Videofluoroscopy

15 Videofluoroscopy Analysis 1. Lip closure 2. Tongue Control 3. Bolus Preparation / Mastication 4. Bolus Transport / Tongue motion 5. Oral Residue 6. Soft Palate Elevation 7. Initiation of Pharyngeal Response 8. Tongue base retraction 9. Laryngeal Elevation 10. Anterior Hyoid Excursion 11. Epiglottic Movement 12. Airway Closure 13. Pharyngeal Contraction & stripping wave 14. Pharyngoesophageal opening 15. Pharyngeal Residue 16. Oesophageal Clearance Oral Pharyngeal Oesophageal

16 Acquired Communication Disorders Any adult presenting with speech or language difficulty Usually as part of an acquired or progressive neurological condition

17 Speech & Language Disorders DYSARTHRIA Motor Speech Disorder Weakness of the muscles used for speech production Slurred speech, slow speech rate, reduced tongue/lip/jaw movement, abnormal pitch or rhythm Messages from the brain to the mouth are disrupted APRAXIA OF SPEECH Motor Speech Disorder Words/sounds produced incorrectly, despite no muscle weakness Difficulty imitating sounds, inconsistent speech errors, groping of the tongue/ lips to make specific sounds APHASIA Language Disorder Damage to the part of the brain responsible for language Can impair comprehension, verbal output, reading & writing

18 Speech & Language Disorders DYSARTHRIA Motor Speech Disorder Pacing of speech Strengthening muscles Improving breath support Compensatory strategies Alternative communication means APRAXIA OF SPEECH Motor Speech Disorder Planning, sequencing and coordination of muscles for speech Pacing APHASIA Language Disorder Comprehension Word finding and language processing Supporting effective conversations with spouse / family members

19 Inpatient and outpatient service: Swallow assessment Videofluoroscopy Voice therapy Speech/language assessment and therapy (direct line) (01) (allied therapy secretary) Referrals can be faxed to (01) Or posted to Beacon Hospital Speech and Language Therapy