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Patients & Visitors

Speech & Language Therapy

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About |  Inpatient Service | Outpatient Services | Swallowing | Communication | Patient leaflets | The Team | Contacts

Overview

The Adult Speech and Language Therapists (SLTs) provide an inpatient service to any adult who is admitted to the RUH and is referred to our department. Outpatient ENT and Head and Neck patients will be seen if they meet the referral criteria (please see the relevant pages).

Speech and Language Therapists are experts in providing assessment, advice, information and support, to adults who have difficulties with:

Communication

  • Motor speech difficulties - e.g. dysarthria (slurred or uncoordinated speech associated with a neurological condition such as a stroke, or following head and neck cancer surgery)
  • Language difficulties - e.g. aphasia (difficulties with understanding or using language after a stroke or head injury)
  • Voice difficulties - e.g. muscle tension dysphonia or vocal fold nodules

Swallowing

  • Dysphagia (difficulty swallowing) - e.g. coughing or choking when eating and drinking, food sticking in the throat

Patients who can benefit from the service

People with the following conditions may have communication and/or swallowing difficulties and benefit from being seen by a Speech and Language Therapist:

  • Stroke
  • Parkinson's Disease
  • Dementia
  • Voice disorders
  • Head and neck cancer
  • Communication and swallowing difficulties associated with ageing
  • Motor Neurone Disease
  • Multiple Sclerosis
  • Head injury, plus others

Our Services

The Adult SLT service based at the RUH provide acute services to patients in the
Acute Inpatient Service setting and two Outpatient Services :
  • Voice
  • ENT / Head & Neck Cancer Services

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Acute Inpatient Service

The Adult Speech and Language Therapy (SLT) Service works across all adult wards within the RUH. We accept referrals for communication and swallowing difficulties.

Opening times

General Wards
Monday – Friday service.
8:30am - 5pm.
Acute Stroke Unit (ASU)
SLTs are able to provide a 7-day service to patients on the ASU.

Discharging from the Service

Patients are discharged from the SLT service for the following reasons:

  • They have achieved all of their goals
  • No further intervention is required, for example, the person has reached their maximum potential or is to be palliatively managed
  • They are discharged from the acute inpatient setting

SLTs provide as much information to the patient and their family / carers as possible during their acute inpatient stay. This includes written advice and recommendations on the person's discharge summary. SLTs also leave written information at the person's bedside, and this should be given to the person to take away with them when they are discharged from the RUH.

The SLT service will organise onward referral, if appropriate, to other community SLT services in the area.

Outpatient Services

The Adult Speech and Language Therapy (SLT) Service offers two outpatient services, based at the RUH:

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Swallowing

What is dysphagia?

Dysphagia is the term used for any kind of swallowing difficulty or impairment.

Dysphagia can be a life threatening condition. The reported prevalence of dysphagia for certain conditions can be found below:

  • 41% people with Parkinson's disease
  • 33% of people with multiple sclerosis
  • 68% of people with dementia
  • 40% people immediately following a stroke

Dysphagia can result in malnutrition, dehydration, choking and aspiration (food or fluid entering the lungs). Aspiration can lead to hospital admission, prolonged use of antibiotics and ultimately death.

Dysphagia can also lead to a decrease in quality of life, wellbeing and socialisation.

How is dysphagia managed?

Dysphagia is assessed by specialised Speech and Language Therapists (SLTs). The management of dysphagia takes place within a multi-disciplinary team.

SLTs are the only professionals qualified to assess dysphagia and make recommendations regarding swallowing.

The role of the Speech and Language Therapist is to provide:

  • Effective assessment through the use of unique specialist skills and knowledge
  • Information to the person and their family and / or carers regarding normal swallowing, swallowing difficulties and the reason for recommendations
  • Education and information to the person and their family and carers, in providing an optimum environment for eating and drinking and enhance function in the later stages of their condition
  • Information and education, including equipment, which may help to preserve the person's independence with eating and drinking
  • Support to the person and those involved in their care to maximise their knowledge and skills in the self-management of their condition, to maximise quality of life
  • Specialist input to inform decision making around complex swallowing difficulties and non-oral feeding
  • Training in the management of dysphagia to promote good care and reduce unnecessary hospital admissions

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How do SLTs assess and manage dysphagia?

The speech and language therapist will assess and manage the person's dysphagia in the following ways:

  • 'Bedside' assessment – this will involve assessing the cranial nerves involved in swallowing and possibly giving the person a variety of different food and fluid textures and consistencies to swallow
  • A cough-reflex test may be carried out as part of the above assessment
  • Reporting on the swallow function and level of dysphagia
  • Recommending the safest food and fluid consistencies and textures for that person
  • Reviewing recommendations as appropriate
  • Referring on for instrumental assessment, such as Videofluoroscopy (VFS) or Fibreoptic Endoscopic Evaluation of Swallowing (FEES)
  • Recommending certain positional strategies or swallowing techniques to either improve the safety or efficiency of the swallow function
  • Recommend any therapy exercises which may be appropriate
  • Liaise with any appropriate professionals involved with that persons care
  • Write a detailed report documenting the dysphagia and recommendations made
  • Discharge the person when appropriate

What are the different food and fluid consistencies?

There are NEW nationally agreed descriptors for different food textures and fluid consistencies (International Dysphagia Diet Standardisation Initiative – IDDSI).  This means there is a standardised terminology which is used to describe food and fluid which should be transferable between hospitals, nursing homes, day centres etc., anywhere within Britain, Europe and the World.

          

A comparison table can be found here:

Modified Diet Food and Fluid Levels

Food Descriptors:

Fluid consistencies:

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Communication

Many conditions have associated communication difficulties. For example:

  • Stroke
  • Parkinson's Disease
  • Dementia
  • Head injury
  • Motor Neurone Disease
  • Multiple sclerosis
  • Head and neck cancer, plus more

In the UK:

  • 2.5 million people in the UK have Speech, Language or Communication Needs (SLCN)
  • 50,000 people who have a stroke every year have speech and language difficulties
  • 700,000 people with dementia experience SLCN
  • About 70% of people with Parkinson's disease will experience communication difficulties, largely with their voice

There are 3 main types of communication difficulties:

    Motor Speech Disorders (e.g. dysarthria)
    difficulties with spoken output such as slurred speech

    Aphasia
    difficulties with understanding or using language after a stroke or head injury

    Voice difficulties
    such as muscle tension dysphonia or vocal fold nodules

A communication difficulty can have a significant effect on a person's quality of life. It could prevent them from being able to participate in everyday life. They may become unable to socialise with friends or family, or stop them from being able to use the telephone. This may result in them becoming isolated and/or depressed.

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Motor Speech Disorders

Motor Speech Disorders is the umbrella term for conditions which affect speech and voice quality. These include: dysarthria and apraxia of speech.

Dysarthria – may result in changes in phonation (voice quality), resonance and articulation due to changes in muscle tone or bulk, following surgery for example. Speech can be perceived as slurred and in some cases unintelligible.

Apraxia of Speech – is when the person has difficult selecting the correct motor pattern for the phoneme (sound) they wish to say. They may be unable to say certain phonemes to command or may say the incorrect phoneme when prompted.

Causes of motor speech disorders include:

  • Stroke
  • Parkinson's Disease
  • Traumatic Brain Injury
  • Brain Tumours

These conditions can exist independently or they can co-occur with each other, or with conditions such as aphasia or dysphagia.

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Aphasia


Aphasia is an acquired language disorder which may affect a person's ability to use and understand language. It can affect one or more of the following modalities: reading, writing, speaking and listening/understanding spoken language. It can also affect numeracy.

Causes of aphasia include:

  • Stroke
  • Head Injury
  • Brain tumour
  • Brain infection - e.g. encephalitis
  • Neurological diseases - e.g. Parkinson's disease and epilepsy
  • Dementia
  • Drugs misuse

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Voice difficulties


Voice difficulties can lead to changes in voice quality (dysphonia) and / or the complete loss of voice (aphonia).

Causes of conditions which can lead to voice difficulties include:


  • Specific conditions which affect the voice, e.g. vocal fold nodules, polyps, muscle tension dysphonia and Gastro oesophageal reflux disease
  • Neurological conditions, e.g. multiple sclerosis, motor neurone disease and Parkinson's disease
  • Other disorders which can affect voice, e.g. asthma, HIV and AIDS

For more information on the outpatient voice service we provide click here.

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How do Speech and Language Therapists assess and manage communication difficulties?

Speech and Language Therapists (SLTs) have an instrumental role in the assessment and management of communication difficulties.

Assessment – we are able to provide detailed assessment of an individual's speech, language and communication strengths and weaknesses. This can lead to a differential diagnosis of the individuals communication difficulties.

Management – once an assessment has been completed, the SLT can formulate an individualised management plan which either rehabilitates and/or compensates for the person's communication difficulties.

This can include:

  • Formulating therapy to rehabilitate specific areas of difficulty for the patient
  • Recommending specific strategies that staff/family/carers can use to help facilitate communication e.g. repeating key words and phrases, using cueing strategies and checking understanding by asking questions
  • Suggesting alternative modes of communication e.g. writing things down or using apps/iPads
  • Training for staff/family/carers on how to communicate with a person with additional speech, language and communication needs - e.g. communication passport training or easy-read menus

Anyone who requires further SLT input for communication following discharge from hospital will be referred on to their local SLT service.

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What can you do to aid communication for people with communication difficulties?

  • Write key words down
  • Talk at a slower pace (but not so slow that it becomes unnatural)
  • Use objects and photos to aid comprehension
  • Repeat key words and phrases
  • Use simple sentences and instructions
  • Check you have understood the person by asking them questions about what was just said
  • Check they have understood you
  • Encourage the individual to use other methods of communication if they have difficulty speaking e.g. writing or drawing, pointing, gesturing
  • Complete a hospital passport so all members of staff are aware of key information about the patient and can use the 'best ways to communicate' with them
  • Make sure menus and signs are 'easy-read', especially in wards with high numbers of patients with additional communication needs

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Patient information leaflets

About your Stroke (aphasia friendly)

Dysarthria

Dysphagia

More about Dysphagia (swallowing problems)

Videofluoroscopy (VFS)

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The Team

Acute Dysphagia Lead
  • Melissa Varia
Voice Specialist and Inpatient SLT
  • Becky Pike
Head & Neck Cancer Specialist
  • Henrietta Samler (Clinical Lead, Head and Neck)
Inpatient SLTs
  • Amy Watkins - (Clinical Lead, Acute)
  • Sarah Green
  • Emily Parker
Acute Stroke Unit (ASU) SLTs
  • Becky Ware - (Clinical Lead , Stroke)
  • Emily Parker
  • Fawn Sawyer
ITU
  • Jo Lamb - (Clinical Lead, ITU)
Neurology Ward SLT
  • Catherine Cawley - (Clinical Lead, Neuro)

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Contact Us

For general enquiries, please contact us at:

Adult Speech and Language Therapy
Therapies Dept
Royal United Hospitals Bath NHS Foundation Trust
Combe Park, Bath
BA1 3NJ
Tel: (01225) 82 1241

Find Us

We are located in the RNHRD and Brownsword Therapies building, to the left of the RUH main entrance. Adult SLT is signposted as Department F1.

Location Map

Travel arrangements

We ask that you make your own arrangements as often as possible.
The ambulance/ambulance-car service stipulates medical grounds for booking transport.

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