Caseload
Patient
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SLT
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Team
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Diagnosis/ relevant/ discharge information
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Current swallowing goals treatment plans and progress
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Current communication goals/ treatment plans and progress
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How frequently should they be seen and by SLT or TA?
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Form updated by SLT’s on an open drive, so that
for MDT meetings/ when people were away it was clear where the patient were in
terms of rehab.
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Weekly timetabling meeting – tick off who is
seeing which patient + can see if any patients were missed.
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Daily patient timetabling – flexible – can see
new patients/ + often patients go for investigations. Joint sessions, goal
planning, groups TOMS and MDM’s pre planned.
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Try to record as much of what you do as possible
Care packages
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Consider what service patients are given across
all of the SLT’s e.g. informal screen – recommendations – further assessment –
therapy. This would allow us to explain to commissioners what package of care
we offer.
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Write care plans with Long term, short term and
session goals on them.
Goal Setting
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Involving patients and their families early on
in finding functional meaningful goals lead to positive outcomes.
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Introducing goals and having an informal
discussion with patients about goals was useful before then making MDT goals.
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Accessing therapy was a good goal – i.e. ability
to follow instructions/ order food/ communicate basic needs/ communicate what
activities done in hospital to family/ friends/ communicate with peers.
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Frequently reviewing SMART or short term goals
was important in order to focus goals on achieving long term aims.
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Impairment based goals needed more explanation
to clients.
Family meetings
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Prepare information beforehand and note down
specific examples of behaviours e.g. patient not initiating communication.
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Explain the SLT role and the type of
interactions the patient is receiving and why.
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Briefly explain what you may expect to find with
the neurology.
AAC
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AAC often did not work on the stroke unit due
to: 1) patients continually changing/ priorities changing 2) many patients had
cognitive impairment and were unable to access AAC 3) High variety of staff –
difficult to get everyone to use the AAC
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Topic cards with a main topic + picture on them
and a list of mini topics on the back (attatched together by a pin) worked well
with aphasic patients to support people to understand what they were trying to
communicate and were easy to model.
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Picture charts worked well to enable patient to
communicate basic needs/ make orders of food.
Oesophageal/ voice patients
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Refer to ENT/ gastro for more information before
recommending oral intake/ giving voice exercises.
Low arousal patients/ Global aphasia patients
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Monitor with the Wessex Head Injury Matrix –
looking for: eye contact/ opening/ vocalisation etc.
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Regular mouthcare, sometimes moving on to
flavoured mouthcare.
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Look for spontaneous swallows.
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Assess Yes/No response e.g. Putney Yes/no
assessment with objects
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Joint sessions with PT/OT since these patients
were most responsive when getting moved etc.
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Communication history – find out interests etc –
play music/ ask about family etc.
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Object to object matching? Gesturing object
function, picture to object matching – assess ability to use AAC – see what
supports comprehension e.g. objects of reference or clear choices by holding up
objects.
Locked in patients/ significant expressive aphasia/
dysarthria
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Using a diary to record daily activities enabled
me to communicate with the clients family and gave me information to use in
supported conversations/ yes/no questions/ gesture therapy etc.
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AEIOU – alphabet board with an ‘end of word’
facilitated patients to communicate complicated information.
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Buzzer with a recorded message = simple functional
way of communicating basic needs when paired with a list of yes/ no questions
e.g. Toilet, back to bed, re-positioning, drink/food.
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Yes?no – look for a consistent response and
handover to the team.
Dementia patients
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Find out baseline – may be able to make some
recovery from the stroke damage if cognitively able to engage in activities.
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History – preferred foods/ activities.
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Assess swallowing .
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Often finger foods / sweet flavourful foods are
best e.g. jam sandwich/ yogurt.
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Feeding guidelines – set up meal
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Breakfast/ lunch groups often good feeding
environment.
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Do not recommend tube feeding e.g. PEG unless
you think they may recover from stroke damage.
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Communication guidelines for the ward
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Refer to the dieticians since often variable
intake
Aphasia
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Initial communication screen – naming bedside
objects, following 2-3 stage instructions, yes/no questions, automatic speech
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The cognitive screen on the CAT was a good
indicator of whether a patient would be able to access any impairment based
therapy e.g. if 3minute recognition memory was impaired – unlikely.
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The stroke handbook – patients wanted to know
what had happened to them – can use pictures in the handbook + information form
the doctors to explain why they had a stroke and how it might have affected
them.
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First topics – family, = good topic, work/ home
= good topics.
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Communication history from family
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SMART session goals – record quantitative/
qualitative information during sessions.
Severe Expressive
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Automatic speech – try to elicit any speech
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Reading/ writing assessment
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Activities – personalised cuing therapy,
semantic associations….
Severe Receptive
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Joint work with family/ in functional situations
Group work
Communication group
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Varied between total communication e.g. with
pictures chosen that were relevant to the patients e.g. Bob Marley, having
blood taken…. And supported conversation work.
- Real life resources/ props were engaging for the patients e.g. map/tube map/ menu....
- Real life resources/ props were engaging for the patients e.g. map/tube map/ menu....
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Topics for supported conversation: Food (menus, photo's, recipe's) ,
work, leisure (cinema, reading, shopping, where to go with friends), holidays (map),
Geography (where from, where live, where the hospital is..), Hobbies, music (with CD's e.g. discuss/ put hand up if you like the song), Sport (pictures/ news articles).
Newspaper group
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Newspapers used as prompts – have pictures,
headings, summaries and whole articles as a hierarchy.
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Each patient had their own goal for the group –
the SLT facilitated discussions etc.
Dysarthria
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Functional - communication – guidelines for
staff – pad and paper to write keywords/sentences, ask yes/no questions,
encourage them to give keywords/ single word answers, deep breath go slowly
over articulate. – trial using a communication chart to communicate basic needs
on the ward. Considered use of AAC e.g. lightwriter/ i-pad
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Impairment based – work upwards with dysarthria
(bottom down) therefore if someone has breathing/ respiratory difficulties you
would start on these before any work on articulation/ intelligibility. Minimal pairs work, telephone work,
barrier activities, use the frenchay intelligibility section for a baseline.
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Use a hierarchy e.g. strategies in one to one –
in small group….
Apraxia of speech
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Cognitive Communication Disorders
• Group
work – to increase initiation, get feedback on communication, practice turn
taking etc.
• Create
a communication passport – information about the client and their preferences
and interests (used for a patient with severe cognitive impairments unable to
initiate communication).
• Functional
tasks – e.g. sequencing/ planning when making recipes in breakfast group.
• FAVORS
– assessment for higher level functional assessment of executive skills, memory
etc.
• LA
– Trobe assessment – looks at communication behaviours and how they have
changed, has a section for the client + a family member – you can combine these
and discuss possible goals.
• Access
to therapy – are the cognitive communication defits affecting therapy participation.
Communication screen
1. Object picture matching
2. Spoken word – object matching
3. Written word – picture matcing
4. Naming
5. Repeating
6. Informal conversation
7. Attention/cognition
8. Gesturing object use
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