Speech and language therapy for acquired brain injury
SaLT for person-centred functional communication
Communication is a complex activity involving several parts of the brain. The use of language may be impaired (aphasia) or the physical aspect of speech may be affected due to nerve or muscle damage (dysarthria). In addition, traumatic or acquired brain injury can cause a range of cognitive communication difficulties, such as problems with attention and concentration, memory problems, difficulty with literal interpretation, reasoning and problem solving, as well as difficulty with information processing.
Speech and language therapy is an important part of our multi-disciplinary approach to rehabilitation for adults with traumatic or acquired brain injuries. As well as working with communication difficulties our speech therapist is a specialist dysphagia therapist. Working with people who have eating and drinking difficulties as a result of their brain injuries.
Person-centred functional communication
The nature of communication and swallowing disorders experienced by our service users varies, as does the time post injury. Many people have already had an extensive period of impairment-based rehabilitation. Our focus is very much on person-centred functional rehabilitation.
Before developing a speech and language therapy programme for an individual, the Home Manager and Speech and Language Therapist discuss the approach in terms of assessment and treatment. For some individuals, assessment and report is sufficient, while others will require ongoing therapy. The nature of intervention is based on assessment findings, prognosis and discussion with the team.
Due to the wide range of speech and language disorders, a wide variety of assessments are used. They may not be used with all clients or may not be used in their entirety, but are based on clinical need. Both formal and informal assessments are used.
The assessments used most frequently are:
- The Mount Wilga High Level Language Assessment
- The MCLA (Measure of Cognitive Linguistic Abilities)
- The CAT (Comprehensive Aphasia Test)
- The Frenchay Dysarthria Assessment
- The Jays Observational Assessment of Dysphagia in Adults
- Dysphagia Risk Assessment adult version
The assessment process includes producing a report, which details the findings from both the formal and informal assessments, along with the recommendations of the Speech and Language Therapist.
Progress and outcome measurement
Progress is reviewed at regular meetings of the Multi-Disciplinary Team and more formally in review reports as requested.
Progress for communication disorders can be difficult to measure on standardised scores, and more frequently comes through changes in a person’s abilities, for example, a service user becoming more confident in their communication and seeking more interaction with other people. We use a variety of mechanisms to evaluate service users’ progress.
Progress within swallowing disorders is more easily measurable. This is measured in terms of reduction of risk of aspiration, reduction in instances of choking and aspiration, increase in nutritional intake, and progression through modified diets and modified fluids.
In addition to working on a one-to-one basis with service users, an important part of the Speech and Language Therapist’s role is to support and enable staff to communicate in the most effective way with service users. The care and support staff help the service users with their therapy on a daily basis. Rehabilitation is not something that can happen once a week, and the whole team approach is necessary to ensure that service users are supported in their functional communication.