Speech and Language Therapy Case Study

Speech and Language Therapy is one of the types of therapy provided by our Multi-Disciplinary Team for people who have acquired brain injuries. As well as helping with communication difficulties, our Speech and Language Therapist treats Dysphagia, or swallowing difficulties, to improve the individual’s well-being and quality of life, as well as reducing the risk of choking.

Mr P
Mr P had a traumatic brain injury following a motorbike accident. He sustained multiple contusions affecting bilateral frontal lobes and the right temporal lobe. He also had acute subdural haematoma and traumatic subarachnoid haemorrhage. He had previously been in a hospital neurological rehabilitation unit and came to The Richardson Partnership for Care 15 months after sustaining his brain injury.

Mr P had multiple impairments as a result of his brain injury, including cognitive difficulties such as problems with memory, attention and orientation, as well as cognitive communication difficulties and swallowing problems.

Mr P had Dysphagia, or swallowing difficulties, due to nerve damage affecting tongue function. This meant that he had reduced ability to chew; when he swallowed the muscle movement in the tongue and pharynx was poor and sometimes poorly coordinated. There was also a delay in closing his airway and allowing the food to pass into the oesophagus. This meant that he frequently coughed and choked when eating and drinking.

He was taking thickened fluids from a specially adapted cup and puree diet that required no chewing. He did not enjoy the food.

Therapy programme
Mr P’s cognitive and language difficulties meant that we were limited in the therapy we could use. It had to be functional and highly motivating.

Mr P worked with a Speech and Language Therapist who devised a specific programme for him. This was combined with daily practice, supported by dedicated care staff.

We worked on his chewing skills using a variety of food types. This increased the intensity at which the muscles were working during the swallow. This programme was a form of progressive muscle training which enabled Mr P to improve the function of his eating and swallowing.

Alongside this we changed the specially adapted cup for a bottle with a sports top lid. This was more ‘normal’ and didn’t draw attention to his difficulties. It also limited the amount of fluid he could get at any one time (as opposed to an open cup).  We changed the thickened fluids to normal fluids, which he could manage because his muscle strength and swallowing coordination had improved through the therapy offered, and also because the smaller volumes were administered with a better head position.

Positive outcome
Mr P progressed well, and within a period of three months he was able to eat a normal diet, enjoying trips out to restaurants with his family.

Please note that we do not reveal the names of our service users in order to protect their privacy.

Helping people with dysphagia to enjoy food safely

Dysphagia (or difficulty with chewing and swallowing) is common amongst people who have had a stroke or other type of acquired brain injury. It is often caused by damage to the nerves and muscles of the head, face and neck and also by damage to the brain. If it is not managed properly, dysphagia can have a significant detrimental impact on the health of the person, leading to malnutrition or dehydration, because of inadequate intake of food and fluids. It can also increase the risk of choking or lung infections caused by food getting into the lungs.

One of the strategies that may be employed to help overcome certain difficulties of dysphagia is thickening liquids so they are easier to control in the mouth, and blending foods to form a paste so that they don’t require chewing.

Understanding dysphagia
Our activity support staff help our service users to prepare and eat meals every day, so it essential that they understand dysphagia. We also believe that people with an acquired brain injury have a right to enjoy their food as much as anyone else, and we try to normalise it as much as possible.

As part of our continuous training programme, our speech and language therapist recently delivered dysphagia training to support workers. They learned about the different stages of swallowing, what can go wrong at each stage and different diet and fluids that can be used to help manage the difficulties people have.

Our approach
Texture, colour, form and variety are important factors affecting the enjoyment of food, so considerable thought and care must be taken to ensure meals are appetising to people with dysphagia. Here are some the points that were covered in the recent training session.

• We take personal preferences into account as well as each individual’s physical abilities and risk factors
• Fizzy water mixed with fruit juice can provide an alternative to thickening for some service users
• Soft foods like salmon mousse and sweet potato pudding add interest and variety
• Meat and vegetables are blended separately so that each retains its individual flavour
• Strong flavours and foods like faggots and gravy blend well to create a tasty meal, which is served with separately blended vegetables
• Fruit smoothies or smooth vegetable soups provide tasty and nutritious thick drinks
• Cooked foods need to be checked before serving as they can change during the cooking process
• Sandwiches can be modified to a single texture using a soaking solution.

Jennifer Cranstoun, a Senior Care Worker who took part in the training session summed up our approach by saying: “You treat individuals as if they are your family. You want to serve them tasty, nutritious meals that they will enjoy.”

The Mews Open Day 2012

DSCF1147_1We held our first Open Day in celebration of the one year birthday of our beautiful Mews home and my word, did we have a great day!

We arranged for all of our Homes and Specialist Support teams to be available to speak to the visitors on the day, as well as answer any questions they had.

The feedback we have received already from the attendees about The Richardson Mews remains as rewarding as ever. Hearing things like  “I can’t believe the quality of this care home” from a care manager in particular is something that really warms our hearts and reaffirms what we set out to do as a business and a caring service provider.

We invited many different people to the Open Day – including a large number of influential professionals from all areas  of the care, medical and charitable professions. We welcomed them into our home and gave them a first hand experience of what it is that we do at Richardsons. Needless to say we were pleased to have them all attend and to get their direct feedback on the work that we do as well as the quality of our facilities at The Mews.

We also presented a talk during the day (morning and afternoon)  which was entitled “Fast Flowing, Slow Stream: Rehabilitation and Psychological Therapies at RPC” – to give some further insights into our approach to rehabilitation. Look out for a blog post on this to come!

Our table top displays were laid out to give a focus on the holistic approach we offer our service users. The different displays showcased the specialist areas of Occupational Therapy, Speech and Language Therapy, Physio, Beauty Therapy, Art sessions, as well as various other trainers from our team giving glimpses and insight into the person-centred approach we choose to take with our service users.

Not to be outdone – we also provided a musical element to the day! We had Martin-The-Music-Man play during the day, as well as Simon Moxman, our saxophone player. It provided a great backdrop to the day. We strongly believe in the power of music in the rehabilitation process and our visitors got to meet and hear our musical team first hand. We regularly have Simon and Martin play for our service users as part of the repertoire of activities which the services users are free to choose to engage in during the year.

Lastly, we would like to thank all of our staff and support teams in helping make the day such a success. We had a wonderful time talking to everyone and really enjoyed having the opportunity to showcase all the work we have put into getting The Richardson Mews’ doors open – its been a long 5 year development project that really has been one of the most rewarding and ambitious dream projects that we have ever embarked on at Richardsons.

And now…we are back doing what we do best – providing the best all-round residential care for adults with acquired brain injuries or learning difficulties.

If you didn’t manage to come and see us on our Open Day – we are more than happy to speak to you at any time or give you a personal tour whenever is convenient for you, so please do call us on 01604 791 266. For more information – please visit our website at www.careresidential.co.uk.