Adult Speech and Language Therapy Information and Support
Information and Support
Please scroll to the relevant section:
Information for people using the SLT service
- Dysphagia (swallowing difficulty)
- what can be done to help communication difficulties?
- useful resources
Information for other health or social care professionals
Information for people using the SLT service
What is dysphagia?
Dysphagia is the term used for any kind of swallowing difficulty or impairment. Difficulties may include:
- Choking, excessive throat clearing or regular coughing when eating and/ or drinking
- Voice regularly sounding wet when eating and/or drinking
- Recurrent chest infections
- Gasping for breath when eating and/or drinking
- Change of colour in the face when eating/drinking
- Unplanned weight loss or dehydration
Dysphagia can be a life threatening condition: if left untreated, it may result in dehydration and malnutrition, serious chest infections, aspiration pneumonia and death.
Swallowing difficulties can also impact upon a person’s quality of life and wellbeing.
If your difficulty is related to the oesophagus (foodpipe), for example, acid reflux, hiatus hernia, please speak to your GP first.
How is dysphagia managed?
Speech and Language Therapists (SLTs) are trained to assess and help you to manage your dysphagia. They are the only professionals qualified to assess and make recommendations for treatment in relation to swallowing difficulties.
They work closely with you, your family and carers, and other professionals, such as your GP, Dietitian and Physiotherapist, to ensure any plans or treatment is understood and in your best interests.
Speech and Language Therapists will work with you to:
- fully assess your swallowing ability, which may include referring you for an x-ray of your swallowing (videofluoroscopy)
- provide you with recommendations for eating, drinking and swallowing, in order to try to maximise your swallow, improve your experience and reduce any risk of aspiration (food or fluid entering the lungs)
- work with you, your family and carers, in providing any therapy exercises or interventions
- help you and those around you, to understand why the difficulties are occurring and how things may change over time. This includes providing information about normal swallowing.
- support you to make any difficult decisions around eating and drinking, and encourage you to be able to manage your swallowing difficulties independently, in order to maximise your quality of life and wellbeing
- communicate with other professionals regarding your dysphagia, in order to ensure everyone involved in your care has a good understanding of any recommendations and treatment
What can be done to help?
There are many things that can be done to help, following a specialist assessment. These may include:
- ensuring your environment is conducive to safe swallowing, for example, looking at the noise levels, seating and distraction (see the my-eating-and-drinking-matters leaflet for more information)
- recommending different food and fluid consistencies (see below)
- providing eating and drinking strategies
- Eating and Drinking challenges in dementia (Eating Drinking Swallowing challenges dementia)
- Golden ‘rules’ for safer swallowing (golden rules)
- providing therapy exercises, which may be carried out at home, or in a clinic using bio-feedback technology
- providing information to carers or nursing homes, to ensure any recommendations are understood and carried out
- training yourself, family members and/or carers in how to thicken drinks effectively (see leaflets below)
- providing information about mouthcare in order to ensure excellent oral health
- advising about specialist products or medications, which may assist, such as dry mouth products or medications to help with saliva control
What are the food texture and fluid consistency levels?
A number of years ago, a project was implemented in order to agree and standardise food and fluid descriptors across the world. These are called the International Dysphagia Diet Standardisation Initiative (IDDSI) (IDDSI – Home)
This means that there is a standardised terminology used to describe food textures and fluid consistencies:
The food and fluid descriptors can be found below, which includes instructions for how to prepare the correct food level and thicken the correct level fluid:
- Normal food
- Level 7 – easy-to-chew foods Level 7 Easy to chew food June 2022 HCRG
- Level 6 – soft and bite-sized food Level 6 soft bite sized food June 2022 HCRG
- Level 5 – minced and moist food Level 5 minced food June 2022 HCRG
- Level 4 – thick pureed food Level 4 pureed food June 2022 HCRG
- Level 3 – liquidised food level 3 liquidised food August 2022 HCRG
High risk foods:
Some foods are much more difficult to swallow if you have a dysphagia. You may find that you can manage some of the foods on the high risk list, but others are not as easy. Some foods may need to be avoided completely.
It is best to discuss this with your SLT who can help to advise you. Please read the leaflet for more information: High Risk foods
- Normal fluid
- Level 1 thick fluid – ‘Slightly thick’ Level 1 Thick fluid June 2022 HCRG
- Level 2 thick fluid – ‘Mildly thick’ Level 2 Thick fluid Oct 2022 HCRG
- Level 3 thick fluid – ‘Moderately thick’ Level 3 Thick fluid HCRG
- Level 4 thick fluid – ‘Extremely thick’ Level 4 Thick fluid HCRG
Communication difficulties can arise from a number of different conditions:
- Stroke or head injury
- Parkinson’s disease
- Motor Neurone Disease
- Multiple sclerosis
- Head and neck cancer
The conditions above can affect communication in a number of ways:
- difficulty with understanding or using language (aphasia)
- difficulty with speech production or clarity (dysarthria and dyspraxia)
- difficulty with the voice (dysphonia)
The above communication difficulties can occur individually or you may have a combination of the conditions.
What is aphasia?
Aphasia is the term given to a difficulty with language – this can be relating to understanding spoken or written words and their meaning, ‘finding’ and expressing yourself, reading and / or writing, and numbers.
Aphasia is acquired – this means it may develop due to one of the conditions mentioned above.
Communication and Dementia
People with dementia may be diagnosed with PPA – primary progressive aphasia (What is Primary progressive aphasia? Alzheimer’s Research UK). This is type of dementia which can cause damage to a person’s language, personality, thinking and emotions.
Word finding difficulties and slowed processing of information can be a ‘normal’ part of the ageing process. However with dementia affecting the language ‘areas’ of the brain, this can be more rapid.
PPA is a neurological condition and changes happen gradually over time – this means that at first any difficulties with communication (understanding or speaking, reading or writing) may be subtle. However, communication may become more impaired and may be lost completely.
See below for further information about how SLT can support you and your family, and information leaflets.
Motor Speech Difficulties: Dysarthria
What is dysarthria?
Dysarthria is a ‘motor’ speech difficulty and may result in problems articulating speech and sounds. The voice and the muscles used for speech may be affected.
This may be due to a weakness or lack of bulk and tone in the muscles (e.g. due to a stroke or nerve damage) or may be due to surgery, for example with head and neck cancer.
Speech may sound slurred or slow, or there may be difficulties with intonation.
Motor Speech Difficulties: Dyspraxia
What is dyspraxia (or apraxia)?
Dyspraxia is a difficulty with coordination of the muscles used in speech production. You may find it difficult to form speech sounds or groups of sounds, and may perseverate on a word or sound.
Dyspraxia again occurs usually as a result of a stroke or brain injury.
Voice difficulties can occur as a result of muscle tension, vocal fold nodules, acid reflux and other conditions, or as a result of a neurological disorder such as stroke, Parkinson’s or MND.
For an SLT to treat any voice difficulties, a referral to ENT is usually required.
The community SLT team are able to treat voice difficulties which have arisen as a result of a neurological disorder.
All other voice difficulties need to be referred to the Voice service at the Royal United Hospital. You can access this service via your GP.
We do not currently have a stammering service however can assist in directing you to an appropriate local service.
What can be done to help communication difficulties?
A referral to Speech and Language Therapy is essential.
SLTs will firstly assess the communication difficulty and identify the areas of communication breakdown.
The SLT will then work with you to find ways to maximise your communication skills. This may be through:
- specific language / speech / voice targeted rehabilitation ‘exercises’
- identifying and practicing communication strategies
- working with those around you to assist in making communication and conversations as effective as possible
- identifying if any communication aids may be of help, for example low tech aids (e.g. communication books) or high tech aids (such as technology, apps and computers).
Your SLT may offer you appointments at home, in an outpatient clinic or via a video link. You may need some individual therapy or therapy via a group.
You and your SLT may go to local places to practice and implement communication strategies, for example, your local coffee shop.
Stroke and Head injury:
Dementia and PPA:
- Alzheimer’s Society (alzheimers.org.uk)
- Specialist support to families facing dementia | Dementia UK
- Rare Dementia Support
- Parkinson’s UK
- Parkinson’s service in Bath – Parkinson’s and Related Conditions Service – Bath and North East Somerset Community Health and Care Services
- Neuro and Stroke Service in Bath – Neuro and Stroke Service – Bath and North East Somerset Community Health and Care Services
- Motor Neurone Disease Association MND Association
- Multiple Sclerosis MS Society UK
Information for other health or social care professionals
The Speech and Language Therapy service accept swallowing and communication referrals for all adults over 18 years of age who live in Bath and North East Somerset (BaNES) or are registered with a BaNES GP.
Communication assessment – anyone can refer
Dysphagia assessment – referral needs to be made by a medical, health or social care professional
Which team do I need?
If the person has had a stroke in the last 3 months, has a complex neurological condition e.g. MND, or multiple health needs which require intervention from multiple disciplines, please refer to the Community Neuro and Stroke Service.
If the person has Parkinson’s Disease or a movement disorder, please refer to the Falls and Parkinson’s Service.
If the person has a learning difficulty, please refer to the Complex Health Needs Service.
If the person has any speech, voice, communication or swallowing difficulty as a result of head and neck cancer or voice difficulty, which is not resulting from a stroke or progressive neurological disease, please refer to the RUH.
For all other referrals – please contact the Care Coordination Centre (CCC) to make a referral – telephone 0300 247 0200
Swallowing Referrals and Advice
Before referring to SLT, please consult with the following documents:
- Decision making flowchart – please use this to help with decision making about referrals and managing the swallowing environment: Referral Flowchart for Care Homes
- My eating and drinking matters – please try to implement these changes where possible, before referring: my-eating-and-drinking-matters
- Eating and drinking challenges in dementia – some of the strategies in this leaflet may help to manage and / or resolve some of the most common challenges for a person with dementia who has eating, drinking or swallowing difficulties: Eating Drinking Swallowing challenges dementia
- Swallowing diary – please complete a week of diary to go with any swallowing referral. It may also indicate that the concern could be managed without the need for SLT intervention, or that the issue was an isolated incident: Swallowing diary
- Contra-indications to referral – please see the list of enclosed issues which would not constitute an SLT referral or need. Please contact the SLT team for advice should you be unsure about a referral you may wish to make: Inappropriate referrals to SLT
You may wish to display the above documents in a staff area or on a notice board. It may also be helpful to display the IDDSI modified food and fluid levels for staff awareness and information.
Staff may wish to carry out some e-learning in the field of dysphagia and swallowing difficulties. There are some good training packages available. There are examples below, however this list is not exhaustive:
- Elearning for Healthcare – your organisation will need to register to allow staff to access the free course elearning for healthcare
- Nutricia – A guide to Dysphagia | Nutricia UK
- Nestle Resource – Cooking with Confidence
For further advice, information and support about dysphagia, please also see:
- Royal College of Speech and Language Therapy – Home | RCSLT
Training from SLT
You may wish to consider having your staff trained in dysphagia.
One Day Dysphagia Awareness Course
The SLT team will be offering a one day course in the near future which will cover the following:
- what is normal swallowing?
- what is dysphagia?
- what are the IDDSI levels for food and fluid, and how are these prepared?
- equipment which can support someone with eating, drinking and swallowing
- management of swallowing difficulties
- pre-produced modified food – tasting session delivered by a relevant company
- practical activities
Please get in touch if you feel this is something you would like your staff to attend.
Soon the SLT team will be bringing a dysphagia roadshow to you! This will involve leaving your home with resources and information, to view at your own leisure. There will also be chances to meet one of the SLTs from the team, ask any questions and practice any skills, such as how to thicken fluids correctly.