World Voice Day 2016 - the role of speech and language therapy at the RNOH
Research shows that good communication between staff, patients and their families can reduce anxiety and frustration. To celebrate World Voice Day on 16th April this year, we heard from Sarah Morgan, Jackie McRae and Hannah Chalke of RNOH’s Speech and Language Therapy Adult service team about some of the important work they do within the hospital to facilitate good patient outcomes.
"Our team sits within the therapies directorate at RNOH and we are members of the tracheostomy team and Spinal Cord Injury Unit. Our work is specialised and we see a variety of patients; predominately those with spinal cord injury, spinal surgery, and those with breathing problems requiring help using a ventilator – we look particularly at how the mouth and throat work to enable an individual to speak, swallow and breathe.
It’s a small service with only two staff members on-site, so we are always busy! Our role within RNOH involves seeing inpatients and outpatients, who may be experiencing difficulties eating, drinking or communicating. We regularly provide training for staff here and to other hospitals. We also have a strong commitment to research and innovation – projects have included; improving oral hygiene on the intensive care and spinal injury unit for those with swallowing problems. Jackie is currently studying an NIHR funded PhD which aims to improve the identification and management of swallowing and communication problems in acute spinal cord injury. We have presented at a number of national and international conferences, including the International Spinal Cord Society conference, the Intensive Care Society and the UK Swallowing Research Group conference.
Speech and language therapy is a profession that covers so many things, the title itself can have its own problems – a lot of people don’t know what we do! We are always willing for people to come and spend time with us to find out about the service and the research we’re doing.
We use our mouth and throat to breathe, talk and eat, all of which require precise and timely co-ordination. Things that most of us take for granted. To produce a phrase for instance, about 100 muscles of the chest, neck, jaw, tongue and face must work together. The ability to talk makes us uniquely human and human communication is grounded in co-operative and shared intentions. It is an essential and very important human need as well as a basic human right. We look at the whole communication system to allow our patients to express their needs and help them participate in their care as much as possible. What you don’t say is sometimes just as important as what you do say. Nonverbal communication, or body language, speaks volumes too and includes things such as posture, eye contact, touch, space, facial expression. For our patients who have had a spinal cord injury some of these non-verbal skills are lost and so the ability to talk becomes even more important.
If we think about swallow impairments, broadly, our three aims would be to make sure you get enough nutrition, to make sure it is safe and doesn’t end up ‘going the wrong way’ but also to make sure it is pleasurable. The last one should not be overlooked. Each patient is unique with a different set of challenges and interactions with their world. We had one patient who had terrible swallowing problems and he just wanted to be able to go out for coffee with his teenage daughter – that was the biggest thing in his life and so we worked towards him being able to drink a cup of coffee safely. It wasn’t important for him to eat yogurt, or other food that we sometimes focus on. It has to be functional and real and mean something to that person.
We try to provide high intensity therapy and develop a therapy programme specifically for each person. We have state-of-the-art swallow equipment on-site which allows us to accurately assess and treat swallowing problems effectively and we get really good results for our patients.
We work closely with the patient and their family, and this is really important to get the most out of their rehabilitation. Good communication can really reduce anxiety and frustration, and if you can manage the psychological side of things it can have a positive impact on physical outcome too. We are fortunate to work with many patients from the beginning of their injury all the way through their rehabilitation and once home. It’s a real privilege.
We also work with and rely on input from our other colleagues in the Trust. They include the dietitians, physiotherapists, occupational therapists, nurses, doctors, pharmacy, psychology, psychiatry and outreach teams. It’s definitely a team approach to managing communication and swallowing impairments and no two days are ever the same!"
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