Speech and language therapy in stroke care

Question 1

Acute

Answer 1

Initial screen of swallow on admission

Swallow therapy at least 3 times a week

Initial language/ speech screen within 72 hours

Follow up language therapy

MDT working and support

Question 2

Community

Answer 2

Follow up assessment

3-4 months of therapy

Working alongside family, carers, nursing home staff

Support getting back to community activities and work

Link to community support

6 month review and offer further treatment if appropriate

Question 3

Types of communication difficulties following a stroke

Answer 3

Aphasia

Motor speech disorders: dysarthria and apraxia of speech

Cognitive communication disorder

Question 4

Dysphagia statistics

Answer 4

Between 40-78% in stroke survivors

76% will remain with moderate to severe dysphagia and 15% profound

Question 5

Dysphagia

Answer 5

Impairment at any 4 stage

• pre-oral
• oral
• pharyngeal
• oesophageal

Question 6

Consequences of dysphagia

Answer 6

Aspiration pneumonia

Malnutrition

Dehydration

Choking

Death

Question 7

Helping with dysphagia

Answer 7

Adaption of posture

Environmental changes

Modifying diet and fluids

Educating family/ carers

Compensatory strategies

Swallow rehab exercises

Adaptive equipment

Question 8

What to look out for with dysphagia

Answer 8

Coughing whilst eating or drinking

Eyes watering, shortness of breath, choking episodes, reduces sats just after swallowing

New and/ or recurrent chest infections

Question 9

Risk factors of dysphagia

Answer 9

Dependent on feeding and oral care

Poor positioning

Reduced definition

Comorbidities

• COPD
• frailty
• alertness
• cognition

Question 10

Aphasia statistics

Answer 10

1/3 people who have a stroke experience communication difficulty

Estimated more than 350’000 people living with aphasia in the UK

Question 11

Aphasia

Answer 11

Acquired language impairment

Usually associated with damage to left cerebral hemisphere

Can affect 4 modalities of language:

• speech/ auditory comprehension
• reading/ writing

Question 12

Difficulties with aphasia

Answer 12

Take part in conversation

Talk in groups or noisy environments

Read a book

Understand or tell jokes

Follow television or radio

Write letter or fill in form

Use telephone

Use numbers and money

Question 13

Expressive difficulties

Answer 13

Word finding difficulties

Non fluent output

Short, staggered sentences

Difficulty with past/ present, he/ she

Question 14

Receptive difficulties

Answer 14

Long muddled sentences

Use of non-words

Unable to understand what others are saying

May not be aware of impairment

Question 15

Dysarthria

Answer 15

Difficulty in speaking resulting from weakness or loss of control of muscles

Speech can sound slurred or unintelligible

Varies from individual to individual

Question 16

Apraxia of speech

Answer 16

Inability to control muscle used to form words

Message to from brain to mouth are disrupted

Speech is uncoordinated and effortful

Many sound and word errors

Often very frustrating for the person

Question 17

Cognitive communication disorder

Answer 17

Result from damage to frontal regions of the brain

Talk too much or not enough

Interrupt conversation

Jump from topic to topic

Give too musch or not enough eye contact

Over or under share

Show impulsive behaviours

Have reduced facial expression