
Module 3: Diverse skills and roles
3.3 Speech & language therapy
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 PDoC, this core role for speech and language therapists has to be different for 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. In the second video Amy describes how swallow can be re-educated for patients who emerge into a greater level of awareness.
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: Amy Pundole describe the role 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.
Post a comment below
Is there any thing we’ve missed out when thinking about the role of speech and language therapists?
One suggestion was to add some information about the SLT’s role in emergence from PDoC – so you can find a link to a resource to a about that in the comments section below.
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Would be nice to include some points on assessing clients communication who may be emerging/ trying to speak and what tools are best used to support this.
Thanks for this suggestion Caitlin – good idea! Recommendations welcome
I’d recommend Amy Pundole’s talk on “Assessing Emergence from a PDoC” https://www.rhn.org.uk/news/assessing-emergence-from-a-prolonged-disorder-of-consciousness/
Helps out to find better ways to communicate with patients.