‘Speech and language therapy? That’s for much later down the line… ‘.
This was the most common comment I overheard whilst promoting speech and language therapy at the local Alzheimer Scotland resource centre drop-in day. I heard it from a variety of sources: people with dementia, their carers and a few professionals too. I heard it more than once that afternoon. It forced me to consider that, despite an upsurge in developing dementia specialists within our profession, the general public are not aware of the things speech and language therapy might have to offer them. If people aren’t sure exactly what we do, do they know what we don’t? I’ll try to dispel some myths.
‘Speech and language therapists are only involved in managing swallowing disorders later in the condition’.
It’s true that we are well-known for stepping in to offer advice and support around end-of-life swallowing issues. We can facilitate difficult conversations around care and feeding issues in advanced dementia. But we can be useful to identify early and subtle changes in swallowing too. Not only can we offer strategies and advice to keep people eating and drinking safely, but we can provide people in the early stages of the condition with opportunities to make their preferences known.
I’ve used ‘Talking Mats’ to establish food and drink ‘loves and hates’. This has proved useful later on if someone is presented with a personal menu horror – no wonder people refuse to eat it! Providing families and carers with the tools to glean this information and then presenting it in an accessible format for use in new situations can be invaluable. Similarly, education about feeding and swallowing difficulties is useful at any stage of the condition.
We run ‘Feeding and Swallowing Workshops’ in care homes to help carers to identify signs of swallowing problems and when to refer. Other published resources such as the ‘Communication and Mealtimes Toolkit’ (NHS Dumfries & Galloway) provide simple solutions to resolve everyday challenges around mealtimes.
You can see a copy of the resource here.
‘I’ll need to mind my ‘p’s and q’s when I’m talking to you’
Speech and language therapists are not elocutionists. We love accents, dialects, slang and colloquialisms – just bring yourself! If a message is being communicated successfully, that’s what matters. We encourage all modes of communication equally – gesture, speech, drawing, charts, tablets/iPads, eye contact and facial expressions. It’s empowering for a family to learn to adapt their conversation style to meet the needs of their loved ones. You don’t have to pronounce all your ‘t’s’ and use fancy words – just engage fully in the interaction and we can work together to understand each other.
‘We don’t need to see a speech and language therapist until much further down the line’.
Some types of dementia present initially with subtle language changes prior to memory problems e.g. primary progressive aphasia, fronto-temporal dementia. Sometimes, in particular sub-types of the condition, it’s the speech and language therapist who can make the detailed assessments to inform the rest of the team and help the diagnostic process.
We know that breakdowns in communication within any relationship can signify the ‘horsemen of the apocalypse’ for that relationship. When a person has dementia this is even more likely. The person living with dementia may misunderstand conversations, humour or complicated dialogue, or be unable to express their thoughts effectively, and this often leads to distress on all sides. Speech and language therapists can advise families and carers on how to adapt their interactions to suit the strengths of the person with dementia and maintain successful communication. This gives the families and carers the understanding to empathise with the person they care for, see the world from their perspective and make sense of new and challenging experiences in the relationship.
“There are not many speech and language therapists in dementia care?”
There is a growing population of speech and language therapists who have a specialist interest in working with people living with dementia. As the number of people with dementia continues to grow, all speech and language therapists working within the adult field will come across people with dementia in a variety of settings in their daily work. Speech and language therapists may also have a large proportion of people on their caseload without a diagnosis. As a profession we continue to develop our interest, skills and knowledge with this client group.
“Speech and Language Therapy works for people with dementia”
Very true. We are running national campaigns called “Giving Voice”, (givingvoiceuk.org/dementia) to help increase speech and language therapy staffing and meet national demand. Partnering this with our expertise in communication and swallowing, we are valuable members of the multidisciplinary team at any stage of the dementia journey. The final quote that gives me hope was from a lady referred for speech and language therapy via Alzheimer Scotland, @alzscot, who said
‘I didn’t know I needed a speech and language therapists until I actually had one’.
What would you like to achieve if you/ a relative could see a speech and language therapist?”
To find out more about how we can work for you, have a look at our recent leaflet. We hope you find it useful to see how show speech and language therapy could be involved if you, a family member or someone you care for is living with dementia.”
http://givingvoiceuk.org/wp-content/uploads/2014/10/RCSLT_Dementia_A4_flyer_Web_Oct14.pdf
Jenny Keir, Specialist Speech & Language Therapist, NHS Tayside
I am based within the Medicine for Elderly SLT team in Dundee. We are involved in communication and swallowing assessments across a wide range of conditions both in hospital and in the community. I’m developing our SLT dementia service. This involves training, establishing links in new teams, assessment/ therapy and promoting SLT role.
Let's Talk about Dementia 
The Communication and Mealtimes Toolkit is a great resource, thank you for sharing the link as I had this a couple of years ago, but had mislaid my paper copy – probably passed onto someone as so good! It is great to have our awareness of the role of speech and language therapists heightened as it is definitely a case of the more people supporting the lives of people with dementia the better! Thank you.
Social work and Gp did not see need for speech therapy and were surprised when I self referred and got one however due to availability I paid for a private therapist. She diagnosed word finding difficulties and techniques to help. Lessons learned please could professionals use carers information rather than assume speaking at somebody and then getting an “agitated and challenging”(professionals assessment) response is due to “the dementia”. When in fact the person is highly stressed and needs help dealing with “challenging behaviour” from professionals who choose, and it is nothing to do with restricted resources, to ignore analysis completed by their peers.
Thank you for responding to my blog. It sounds like you have had a difficult experience. Perhaps you feel that your voice was not heard. I am pleased that you felt the referral to SLT was worth pursuing yourself, despite the conflicting opinions of other professionals. I hope that the techniques to help with your word-finding difficulties were useful. It is another lesson in the importance of a team that can work together and understand each other’s roles and responsibilities clearly. Most importantly, it’s crucial to value and respect the needs of the individual who is clearly asking for help.
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