Introduction
I have started to receive more and more stroke
referrals for patients who have vascular dementia. I have liaised with a
dementia specialist for some advise on the following patient.
Referral
For SLT to improve the patient’s intelligibility.
History
- Stoke
- Reported diagnosis of dementia.
- Recent chest infections and decline in function (falls + infections).
- Previously SLT focused on using a life review book during conversations with friends at a day centre.
- Bilingual - English and Italian.
- The patient's wife reported that his language skills are at baseline.
- She reported that the patient does not consistently recognise family members (herself/ daughter) and forgets information very quickly. The patient's wife reported that the patient is not intelligible on the phone and that they often talk to family on the phone.
- The patient reported that he has speech difficulties.
Assessment
The patient was asked questions about pictures of
family members (a familiar topic). The patient’s wife was asked about her
husbands change in function.
Speech
characteristics
Non-fluent, stuttering speech. Difficulties with
word initial phoneme's - phoneme repetitions. Quiet speech, unclear articulation
and reduced breath support.
Intervention
Carer focused intervention - patient cannot
remember strategies.
Strategies were handed over because the client was
able to use them when prompted repeatedly.
Recommended
skype instead of phone use with distant family.
Normal dysfluency advice - decrease anxiety, not interrupting
the patient when speaking, prompting him to pause between words, slow down his
speech and prolong sounds which he has difficulties with.
Modify environment decrease background noise +
distractions.
Advice from dementia specialist SLT
Progressive - therefore maximise present skills
e.g. non-verbal comm.
Book ' care to communicate - Jenny Powel' - aimed
at carers with dementia
-
Questions to ask/ key things to consider with a dementia client:
- Full diagnosis of dementia ? memory clinic report?
- Can the patient use communication strategies when prompted?
- Insight? E.g. this patient demonstrated some insight into speech intelligibility/difficulties
- Carer education
- Communication of basic needs
- Maximise the patient’s communication strengths e.g. non verbal communication.
