Communication at Risk?
Speech and Language Therapy in Dementia #SLTDementia
I have always felt privileged that I have a job which is never dull and has challenge and reward in equal measure. There is no such thing as a typical week. I work with people newly diagnosed with dementia who have significant communication difficulties. These are most often people diagnosed with a Fronto- temporal type dementia or with language deficits associated with an atypical Alzheimer’s .I have an additional role of Clinical lead for Dementia in Lothian. This means that I constantly juggle day to day clinical work with more strategic work on developing the awareness of the speech and language therapy role in dementia and increasing the knowledge and skills of speech and language therapy . I am most passionate about increasing our role in facilitating communication in people with Dementia and highlighting our role in working with carers. Too often when I speak to colleagues around the country, they see their role as working on the eating drinking and swallowing issues which present a palpable risk and do not consider themselves sufficiently resourced to address the communication issues for which the risk appears less.
A snapshot of my current clinical input involves supporting a person with a progressive language based dementia to use specific apps on an iPad to communicate, as expressive language has gone but reasonable understanding and memory is still retained. We have progressed from this being used within the home to now taking it out and about and it facilitating maintenance of activities of daily living and a social life.
Another person has an unusual presentation of marked expressive language difficulties with severe visuo-spatial and perceptive problems, which is significantly affecting her ability to read and write and precludes her from using strategies such as iPads. I am looking at increasing her ability to use complex gesture to support her communication. Working in a multidisciplinary team and office base allows me to discuss these more complex cases with other colleagues and I have been able to refer to my occupational therapy colleague and jointly think about her management.
I work with a gentleman with a form of Primary Progressive Aphasia that results in stilted and slightly slurred speech. We work on pace, rhythm and production of consonant blends to preserve his intelligibility and to allow him to keep up his active lifestyle in the community.
As I generally work with people newly diagnosed, the emphasis is on maintaining communication skill and developing strategies and supports for when it becomes more troublesome. I get a lot of pleasure from being able to offer ways of increased self management and giving people a sense of control and hope.
Another strand of my work involves managing the difficulties people experience with eating and drinking which becomes increasingly prevalent as the illness progresses. My aim is to do more training and to empower carers to be more responsive to the person’s changing needs by altering the way they approach the whole mealtime process, as well the consistency of the diet and fluids. My colleague Rebecca Kellet has produced an excellent toolkit – Communication and Mealtimes toolkit@NHS Dumfries and Galloway 2012
The Royal College of Speech and Language Therapy Position Paper on Dementia (2005) has been under review and is now out for consultation. http://www.rcslt.org/news/news/2013_News_Archive/dementia_position_paper_consultation
It clearly articulates our role both with communication and eating and drinking, working directly with individuals and indirectly with carers and the multidisciplinary team. A focus group of speech and language therapy ‘s around Scotland met in October to look at how the Position paper dovetails with the 5 & 8 Pillars of Support. This in turn will help inform the AHP Policy Document on Commitment 4.
Dementia is everyone’s business, so is communication to some extent and it is time speech and language therapy ‘s step forward and contribute their particular expertise in analysing and repairing communication breakdown to the benefit of all concerned.
We are inviting you to join in our #SLTDementia conversation with these three questions:
“ENGAGING – ENABLING – EMPOWERING” – Allied Health Professions in Dementia Care
National AHP Dementia Expert Group