In conjunction with Speech Pathology Awareness Week (August 20 – 26), we invited Laura O’Loughlin from Adelaide Speech Lab to tell us how she and her colleagues can support adults living with disability.
What kind of clients do you mostly see in your clinic?
We are a specialist adult clinic- a concept which often surprises people! I find when I tell people I’m a speech pathologist, they immediately think of children with speech or language difficulties and don’t knwo how we fit in with the adult population. We see adults with disability resulting from a range of conditions, including:
- Acquired / Traumatic Brain Injury resulting from stroke, motor vehicle accidents, brain tumours or surgical complications;
- Neurodegenerative Conditions such as Huntington’s Disease, Parkinson’s Disease, Motor Neurone Disease, Multiple Sclerosis, Primary Progressive Aphasia or Dementia
- Voice Disorders such as vocal cord palsy/ paralysis, vocal nodules, chronic cough, occupational vocal loss or muscle tension dysphonia;
- Head and Neck Cancer e.g Brain Cancers, Oral / Tongue Cancers or Throat Cancers
- Respiratory Illness such as Chronic Obstructive Pulmonary Disease, Chronic Covid19 or Lung Cancer
How does a Speech Pathologist support clients with these kinds of conditions?
We can assess, diagnosis and treat both swallowing and communication disorders. When it comes to communication, speech pathologists cover a LOT of areas. In the types of conditions we see, we target speech (the ability articulate sounds), expressive language (ability to formulate your thoughts and subsequently speak or write them), receptive language (ability to understand what is being said or comprehend written words), voice (ability to produce sound using the vocal cords) and cognitive communication (attention, memory, organisation, executive functions and problem-solving abilities).
More often than not, individuals with the conditions mentioned earlier have impairments in more than one of the above areas. For example, individuals with multiple sclerosis (MS) often have difficulty with both speech and voice, as the muscles involved in producing both speech sounds and the voice itself become weaker due to the progressive nature of the disease. There can also be cognitive communication changes seen in MS such as difficulty with executive functions and memory. In this case, our therapy would target the deficits across all these areas as they arise- generally focussing on what is most important to the client as all our services are client goal focussed.
When it comes to swallowing impairment, our role is also quite broad. The main goal is to ensure safe oral intake for our client; we do this by recommending modified diet or fluid textures (which are easier to chew or swallow) and/or safe swallow strategies / techniques, implementing swallow rehabilitation exercises or providing special eating/ drinking equipment that’s more accessible. We often provide a combination of some or all of these. For example, a client with an Acquired Brain Injury following a stroke may have difficulty with drinking regular fluids because of weakness in the muscles required to swallow, as well as cognitive changes causing ‘impulsivity’ with eating (e.g., over filling the mouth). In this case, we might look at thickening fluids as they are slower moving and can work well with delayed/ weak swallow muscles. We would also provide safe swallow advice such as supervision during mealtimes and verbal prompts to slow down when eating. Depending on the muscles affected by the stroke we might also do swallow rehabilitation exercises with the client to try and improve the strength of their impaired muscles.
It is also our role to provide education to family members and care staff on how to safely prepare modified diet textures and thickened fluids, as well as how to reduce the risk of (and know the signs of) choking and aspiration during mealtimes.
How can participants use Speech Pathology in their NDIS plan?
NDIS participants can access clinic or mobile visits from a Speech Pathologist under the capacity building support category of “Improved Daily Living”.
Depending on the individual, our services are targeted at the client’s communication and / or oral intake related NDIS goals. We can also assist clients by providing supportive documentation and reports to the NDIA or other key stakeholders e.g. to assist in applying for an NDIS plan review.
Case Study
James* (*name changed to protect privacy) is a 56-year-old who was referred to us by his neurologist after receiving a diagnosis of Motor Neurone Disease (MND). MND is a degenerative disorder that causes the voluntary muscles to become weaker and weaker, including the muscles needed for speech, voice and swallowing. James told us that he was already having occasional choking episodes with certain foods, and that his voice had gotten ‘quieter’. He also noticed he was slurring his words at times, particularly toward the end of the day when he was tired.
We started by addressing James’ swallow concerns as this was the most urgent giving the choking episodes, which were quite scary for him. We assessed his chewing and swallowing muscles and then tried a range of different food textures until we determined that James was struggling with hard and fibrous textures (such as nuts, crusty bread, meat). We recommended avoiding certain textures and to ensure his prepared meals, particularly meat, were all soft and ‘tender’ as these were more manageable textures for him. We liaised with the MND SA clinic and recommended a PEG tube insertion (feeding tube directly into the stomach) as soon as plausible, as James had already started to lose weight from reduced oral intake and his swallowing was likely to deteriorate quickly. We also organised a voice amplifier for James to use at home and when working from home (during zoom meetings for example) to help increase his vocal volume without him having to strain his already changing voice.
Over the course of 9 months, we started to see James weekly as his condition sadly progressed quite rapidly. In that time, our role / services were constantly changing to address James’ changing symptoms. James had stopped working and was now under 24/7 nurse / care support. He was now having most of his nutritional intake via his PEG tube (which had been inserted several months earlier) and we continued to assist with safe oral intake for comfort and enjoyment. We also completed the voice banking process with James during this time, which involved recording his voice using some set phrases which were synthesised and replicated for use on a communication device. This allowed James to have another way to communicate as his condition declined.
Sadly, James passed away approximately 10 months after we began working together. This is always the hardest part of our role as we become quite close with our clients and families when providing such intensive services. It was a hard journey for James and his family, but we aimed to make part of that journey as seamless as possible by ensuring James was able to communicate his wants and needs for the remainder of his life; as well as manage oral intake safely.
To find a speech pathologist in your area, visit https://www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/Find_a_Speech_Pathologist/SPAweb/Resources_for_the_Public/Find_a_Speech_Pathologist/All_Searches.aspx?hkey=0b04c883-80b2-43e7-9298-7e5db5c75197
Find out more about Laura and her team at Adelaide Speech Pathology Lab