Module 3: Diverse skills and roles

3.3 Speech & language therapy

Speech and language therapists [SLTs] are another of the core allied health professionals who work with PDoC patients. The sway presentation below highlights the key focus of treatment and management they can offer.
Key roles of speech and language therapists

In the films below three experienced speech and language therapists outline key ways in which SLTs support people with a PDoC in three different settings: hyper-acute, rehabilitation and long-term care.

Key roles of the speech and language therapy technician

Speech and language therapy technicians (SLTT) work alongside SLTs.  Below Amy Parfitt talks about the role of the SLTT working with people with PDoC.

Re-educating swallow

Supporting people to eat and drink – and to rehabilitate their swallow is a large component of speech and language therapy work in other areas of neurological care and rehabilitation.  However, due to the severity of impairments in people with a disorder of consciousness, this core role for speech and language therapists has to be conducted differently in this patient group.

In most PDoC cases food or tastes are used most frequently in assessments – with the placing of strong flavours on patients’ lips and watching for a response.  In the first video below Amy Pundole talks about how tasters are used in the assessment of people with a PDoC.

The re-education of swallow can however become possible in those people with a disorder of consciousness who are emerging and have reached an MCS+ level of awareness.  In the second video below Amy Pundole describes how swallow can be re-educated in this patient group.

Oral hypersensitivity and saliva management

Oral hypersensitivity is a common problem for people with a disorder of consciousness.  Gone unmanaged, it can prevent access to their mouth for oral hygiene and impact upon the health of their teeth and gums.

Due to the inability of many people with a PDoC to swallow, this also means they can struggle to manage their saliva.  This can lead to constant drooling.

In the film below Clinical Lead Amy Pundole discussing the management of oral hypersensitivity and talks about how saliva can be managed in these circumstances.

Tracheostomy weaning

In this section, we explore the role SLTs have in the tracheostomy weaning processes.  In the films below physiotherapist Kate Jones and Speech and Language Therapist Amy Pundole describe the roles speech and language therapists (along with nurses) play in tracheostomy weaning.

KEY DOCUMENT

If you are an SLT then have a look at the comprehensive “Guidelines for Speech and Language Therapists working with adults in a Disorder of Consciousness” which were published in 2019. You can find these here.

The Guidelines highlighted above include suggestions of ways of working with patients emerging from PDoC eg with augmentative and alternative communication tools etc. If you are an SLT we recommend that you print out a copy of these guidelines for further study and ongoing reference.

Transferable skills

Working with people with a PDoC has become a highly specialised clinical area over the past 10-15 years. Although this has led to the creation of assessment tools and a range of therapeutic development, over specialisation can also bring problems.  It can, for example, lead nurses or therapists to think they do not have the skills required to treat this patient group and that only specialist health professionals can do so.  This in turn can lead to delays in treatment, unneccesary patient transfers and reduce the opportunities or confidence of more junior health professionals to treat this patient group.

In the clip below Amy Pundole reflects on all the core skills speech and language therapists already have that provide the base for being able to work with PDoC patients.

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Is there any thing we’ve missed out when thinking about the role of speech and language therapists