Speech and Language Therapist

What does a Speech and Language Therapist do on the wards?

Speech and Language Therapists are trained in assessing and treating swallowing and communication problems.

Why might a patient need to see a Speech and Language Therapist after Intensive Care?

It is not uncommon for patients who have spent time on a breathing machine (ventilator) to develop short term problems with swallowing or with their voice. Temporary changes to the sound and strength of the voice can occur, with it sounding quieter, hoarse or breathy.  This is due to being attached to the breathing machine (ventilator) by a breathing (or “ET” or endotracheal) tube in the throat and a weakening of the throat muscles. Problems with swallowing or voice changes are more common among patients who’ve spent longer on the breathing machine (ventilator), although not everyone is affected in this way.

When should the patient expect to be seen by a Speech and Language Therapist?

Not everyone needs to be seen by a Speech and Language Therapist. If swallowing or communication difficulties are picked up in the ICU, patients can be seen by a Speech and Language Therapist while they are still in Intensive Care. It is not always obvious that patients have a problem with swallowing or communication until they go to the general wards and begin to eat and drink normally. Patients might cough or feel like they are choking when they eat or drink and should let the nurses or doctors know. They will ask for a Speech and Language Therapist to make an assessment.

What is involved in the various assessments, tests and recommendations?

There are several assessments, tests, and recommendations that the Speech and Language Therapist might do and provide. These include:

• Simple swallowing assessment:  The Speech and Language Therapist may ask the patient to try foods and liquids of different thicknesses while they check how well they are able to swallow. 
• Swallowing assessment using barium and X rays (videoflouroscopy):This test is done in the X ray department. The patient will be asked to sit or stand beside an x-ray machine while they are given food and drinks of different thicknesses mixed with barium. The barium will allow us to see on the x ray how well they are able to swallow the various foods and liquids. The test may be recorded so it can be watched again later. 
• Swallowing assessment using a special scope (Fiberoptic Endoscopic Evaluation of Swallowing or FEES) This test involves passing a small tube (a fibreoptic scope or camera) into the nose and throat. A local anaesthetic spray can be used to make passing the tube more comfortable. Food and drinks of different thicknesses will be given while the Speech and Language watches the pictures from the camera on a screen. The test may be recorded so that it can be watched again later.
• Swallowing exercises:The Speech and Language Therapist may give some exercises to practice which will help strengthen the swallow.
• Information and advice: The Speech and Language Therapist will give information and advice on which types of food are safe to have until swallowing gets better or back to normal.

What kind of help can the patient get after they go home?

If the patient is seen by a Speech and Language Therapist while in hospital and feels follow up after discharge from hospital is needed they will make a referral to a local community Speech and Language Therapist.

What if patients need more help after they get home?

If the patient has any difficulties with swallowing or communication after they get home, they should talk to the GP to get a referral to be seen by the local community Speech and Language Therapist.

Useful links

www.rcslt.org is the official website of the Royal College of Speech and Language Therapists. Although the website is more likely to be used by Speech and Language Therapists themselves, there is some useful information on finding contact details for Speech and Language Therapists in your area. There is also advice on how to find local Speech and Language Therapists who work privately and how much it is likely to cost (but you will have to pay for this yourself).