The role of a Speech and Language Therapist at STEPS Rehabilitation.

As part of Aphasia Awareness Month, in this Q&A article, our Lead Speech and Language Therapist Joanne Holder, explores the importance of speech and language therapy as part of a rehabilitation programme and her role at STEPS.

What is Aphasia?

Aphasia is when a person has difficulty with their language. It is usually caused by damage to the left side of the brain and can be caused by a stroke, brain injury, brain tumour or a progressive neurological disorder such as dementia.

People with aphasia can experience difficulty with reading, listening, speaking, and typing/writing, with symptoms ranging from mild challenges finding words, to difficulties with all forms of communication.

The main type of treatment for aphasia is speech and language therapy which helps to restore a person’s ability to communicate, along with developing other methods of communication where necessary.

What is Speech and Language Therapy (SLT)?

The Royal College of Speech and Language Therapists (RCSLT) define speech and language therapy as the, “treatment, support and care for children and adults who have difficulties with communication, or with eating, drinking, and swallowing.

Speech and language therapists (SLTs) are allied health professionals. They work with parents, carers and other professionals, such as teachers, nurses, occupational therapists and doctors.”

How long have you been a speech and language therapist?

I have been working as an adult speech and language therapist since 2010. I have a passion for a person-centred rehabilitation and take a holistic approach to enable clients to reach their full potential in relation to communication, eating and drinking.

My experience lies in working with clients who have suffered a stroke or brain injury, and also people who have progressive neurological disorders and complex multi-pathologies. I have a special interest in cognitive communication disorders, aphasia, motor speech disorders, aphasia and mental capacity.

What made you want to pursue a career as a speech and language therapist?

I worked in a neuro-rehab service as a rehabilitation assistant where I was involved in therapy sessions conducted by physiotherapists, speech and language therapists, and occupational therapists. I was fascinated by the impact that different conditions have on communication from changes in speech production to impaired language function, and the approaches taken to restore and compensate for deficits.

I’d always had a strong interest in linguistics and phonetics, and SLT seemed the perfect fit as it drew on my interests, knowledge and skills in these areas. The role is incredibly varied, and I have been fortunate enough to work in a variety of different settings during my career so far.

What role do the Speech and Language Therapists at STEPS Rehabilitation play?

At STEPS, we have created a unique environment that enables our clients to access a wide range of therapies and medical specialists all under one roof. Our team comprises physiotherapists; neuro-psychologists; neurologic music therapists; prosthetic and orthotic specialists; nurses experienced in complex care, occupational therapists and speech and language therapists.

Teams work collaboratively to combine their expertise to deliver comprehensive rehabilitation services to clients who have suffered traumatic injuries and neurological conditions.

The speech and language therapy team typically see up to 4-6 clients a day. On admission to STEPS, the speech and language therapy team meet with the client to establish their concerns relating to swallowing and/or communication and use this, along with information from their support network and medical reports, to inform the plan for assessment. We work together with clients and relevant others to form goals to work on during admission and beyond.

What does a speech and language therapy programme look like?

Following a thorough assessment, we create a therapy programme which is delivered by the speech and language therapy team with support from rehabilitation assistants. Communication and swallowing difficulties can be chronic and we help clients self-management activities as well as educate them in relation to managing any longer term conditions.

Changes to swallowing and communication not only impact on the individual, but their family and wider support network too. Where appropriate family, carers are friends are also involved in the therapy process. Individual sessions vary depending on the client’s communication/swallow diagnosis, prognosis and their goals.

The level of impairment impacts on the work we do with the client. For example, when supporting a client with aphasia, we may focus on word finding at the single word level or use special aphasia apps. We might also work at a more functional level, helping to implement word finding strategies in conversations across various contexts and with their family and friends.

With respect to dysphagia, we support clients to progress from being PEG fed to being able to eat and drink again through dysphagia therapy, including AMPCare.

Some of our clients require devices to help them communicate, such as a GridPad or iPad. We work closely with the specialist speech and language therapists and technicians at Barnsley Assistive Technology Service to assess and trial clients with devices to enable them to communicate and control their own environment.

We are able to link the devices to our TV’s and smart plugs within their rooms. This can increase independence and autonomy of individuals. There are a range of apps available for iPads which are especially effective for clients in between therapy sessions enabling them to practice independently. We frequently use ‘Constant Therapy’ and recently this benefitted a client who was very driven by data from performance on the app. It enabled the client (who had a cognitive communication impairment) to monitor for fluctuations in performance and provided motivation to improve upon his previous scores.

How do your work collaboratively with other specialists at STEPS?

The speech and language therapy team work closely with all members of staff to help them to use optimal communication methods with clients. For example, we work jointly with our nursing and rehabilitation assistant colleagues to support with implementation of communication advice and use of augmentative and alternative communication. The more people who can support a client’s communication, the more a client can be empowered to engage in the decision-making process pertinent to their care and day to day life.

Another good example is ‘STEPS Voices’ which is run with Rebekah Keenan, STEPS’ Neurological Music Therapist. These sessions focus on improving voice skills. Bespoke short-term groups can also be set up with the appropriate client mix to improve communication.

We also work closely with the catering team to ensure that clients who have dysphagia receive meals which are the appropriate consistency and fulfil nutritional needs. We are currently working with the chefs to create dysphagia friendly ice cream so those clients with dysphagia don’t miss out when the ice cream van visits!

There is a lot of preparatory work and resources development for our clients that happens behind the scenes. As the lead speech and language therapist my role also includes developing the service, identifying the training needs of the wider team and ensuring we offer a quality service.

The Speech and Language team at STEPS is currently made up of myself and Annabelle John (Senior Speech and Language Therapist). Together we manage the caseload of clients with dysphagia and communication impairments and develop programmes for assistants to carryout. Annabelle is currently carrying out a valuable mouth care program in conjunction with the nursing team and rehabilitation assistant team.