Case Study: Dementia – communication

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

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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.