Transcript Communication and swallowing matters in Motor

Kit Clewley
Specialist Speech & Language Therapist
05/04/2017
Who am I, what do I do?
 Speech & Language Therapist role
- Dysarthria
- Dysphagia
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Different forms of MND
 Motor Neurone Disease (ALS)
 Progressive Bulbar Palsy (PBP)
 Progressive Muscular Atrophy (PMA)
 Primary Lateral Sclerosis (PLS)
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Dysarthria
 Definition
 Typical symptoms
 Aim of SLT intervention
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Management of dysarthria
 Mild dysarthria
- Adapt environment
- Topic fronting
- Group strategies
- Voice banking
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Management of dysarthria
 Moderate dysarthria
- Over articulation
- Increase pauses for breath
- Strategies to resolve communication
breakdowns
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Management of dysarthria
 Severe dysarthria
- Writing
- Boogie board
- iPad – Predictable application
- Alphabet chart
- Lightwriter
- Alternative communication devices requiring indirect
access
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Management of dysarthria
 Loss of intelligible speech
- Alternative communication devices via indirect
access
- Yes/No system
- Key words/phrases
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Dysphagia
 Definition
 Typical symptoms
 Aim of SLT intervention
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Mild dysphagia: symptoms
- Problems with dry, crumbly or chewy
foods
- Coughing on thin fluids
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Mild dysphagia: management
 Posture
 Double swallow
 Modification of diet textures and fluid consistencies
 Environment
 Dietitian
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Moderate – severe dysphagia:
symptoms
- Problems with adequate oral intake
- Occasional choking episodes on food and
fluids
- Weight loss
- Loss of enjoyment with eating and
drinking
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Moderate – severe dysphagia:
management
 Further modification of diet textures
 Smaller meals more frequently
 Further modification of fluid consistencies
 Increase sensation
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Severe dysphagia: symptoms
- frequent choking episodes on food
and fluids
- inadequate oral intake
- chewing fatigue
- prolonged meals
- patient dreads eating/drinking
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Severe dysphagia:management
 Gastrostomy
 Nasogastric tube (NG)
 Saliva management
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Controlling excess saliva
 Frequent swallows
 Sleeping position
 Avoid phlegm-producing foods
 Papase
 Maintain liquid intake
 Medications
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Referral to Speech & Language
Therapy
 Consultant
 Specialist Neurology nurses
 Professionals trained by SLT
 SLT Departments:–
Maelor Hospital and Deeside hospitals (East)
Royal Alexandra Hospital, Rhyl (Central)
Eyryri Hospital, Caernarfon (West)
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