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Therapy for adults

General information about Speech and Language Therapy (SLT).

Speech and language therapists provide treatment, support and care for children and adults who have difficulties with communication, and /or eating, drinking and swallowing difficulties.

Just like speech and language therapists who work in the NHS, our independent speech and language therapists support those who, for physical or psychological reasons, have problems speaking, communicating, eating, drinking and swallowing.

Our client range is therefore very diverse: from children whose speech is slower to develop, to older people whose speech, language and swallowing abilities have been impaired by illness or injury, and everything in between!

Adults

Adults may require the assistance of a Speech and Language Therapist for a variety of reasons such as speech and communication impairments, hearing impairment, voice disorders, stammering, learning difficulties in adulthood or eating, drinking and swallowing disorders.

Information about specific conditions or disorders are listed below; this list is
not exhaustive:

  • AAC
  • Acquired brain injury
  • Aphasia
  • Apraxia of Speech
  • Autism
  • Dysarthria
  • Eating, drinking and swallowing disorders / dysphagia
  • Head and Neck Cancer
  • Learning Disability
  • Mental Health
  • Palliative Care
  • Progressive Neurological Disorders including Dementia
  • Right Hemisphere Damage
  • Stammering
  • Stroke
  • Voice Disorders and Professional Voice Use

Click on the list on the below to see information on the many different speech, language and communication needs (SLCN) independent adult speech and language therapists can support you with.

Not all independent speech and language therapists will have specific expertise or experience in treating all speech, language and communication needs (SLCN), including eating, drinking and swallowing difficulties.

When considering which independent speech and language therapist to support you and your family, the following questions may help you to guide your decision:

  • What experience do you have working with adults with X’s condition?
  • What specialist training and/ or specific programmes of treatment do you have for working with adults with X’s condition?

Additional specialist training in a specific condition is not always necessary as experienced therapists will have learned many strategies of support over their years of practice, but there are some conditions (e.g. eating, drinking, swallowing etc) where there are particular programmes a therapist may use – it is important for you to understand a therapist’s approach before you engage with their service and they should be able to give you a clear clinical rationale for their approach/es used”

  • Are there any conditions you do not treat?

It is a good idea to let a therapist tell you what SLCN they are not comfortable or experienced helping with. All our independent therapists have a duty to know the limits of their practice and be transparent about this. (A therapist without lots of experience in a particular area may still be able to help you as long as they have appropriate supervision from another, more experienced/ specialist therapist in place, but this is ultimately your choice to make and you should do so knowing the full situation)

  • Where will therapy sessions take place?

Some therapists offer home visits only, others’ clinics, some can go into care settings (care settings permitting) and others may offer all 3 options. There are advantages to each of the therapy environments, just as there are sometimes barriers to each – this will depend on your individual situation.

  • What are your costs?

Make sure you establish all the costs associated with visits before you engage with their service, including any travel costs, initial assessment costs, reports and therapy sessions. Our independent speech and language therapists should provide all of this information to you before you have your initial consultation.

  • How do you store and protect my/ my family members’ data?

All members of ASLTIP must be registered with the Information Commissioners Office (ICO) as per the GDPR Act 2016. They should publish, or be able to give you, a copy of their data protection and privacy policies which state their legal bases for holding your data on file, how they store your data and how long they are legally obliged to do so.

Speech and language therapists who work with adults will have significant post-graduate experience working with these problems.

Click here to search for Adult Speech Therapists in your area.

Some causes for communication problems in adults (where a diagnosis may already be known) include:

Alternative and Augmentative Communication

This refers to other ways of communicating, not speech.

  • Augmentative communication usually refers to non-verbal communication used together with speech. This could be the use of signing, picture symbols or software alongside talking.
  • Alternative communication usually means using an alternative means of communication instead of speech.

The use of AAC can help adults by reducing their frustration when trying to communicate. It helps them to develop their communication and ability to interact socially. It also helps others understand what the adult is trying to say.

For further information around AAC please visit:

More information

Acquired Brain Injury

Any injury to the head can cause brain injury. There are a variety of causes such as a fall, a road traffic accident, infection and disease which can impact adults.

When an injury has been caused by an external force or mechanism, the term used is Traumatic Brain Injury.
The problems arising from brain injury will vary depending on which part of the brain has been damaged and the extent and severity of the damage.

Difficulties may include:

  • Speech and articulation affecting intelligibility
  • Difficulties understanding what is said
  • Difficulties expressing oneself
  • Difficulties with reading or writing
  • Voice disorders
  • Eating, drinking and swallowing disorders
  • Concentration and Memory
  • Behavioural/ personality changes
  • Social skills
  • Thinking – organising, planning and problem solving

More information

Aphasia

Aphasia is an impairment of language, which is most often caused by stroke. It can also result from head trauma, brain tumours or infections.

Depending on the area of the brain that is affected, Aphasia can affect comprehension or expression or, if the damage to the brain is widespread, both comprehension and expression.

Aphasia that affects speaking primarily is called ‘non-fluent’ aphasia. Speaking for people with this type of aphasia is generally slow and laboured and their sentences tend to lack grammatical features and structure.

Aphasia that affects understanding primarily is called ‘fluent aphasia’. People with fluent aphasia tend to speak in more complete sentences (hence the term ‘fluent’) but their understanding is weaker and their sentences often do not make sense.

More information

Apraxia of Speech

Acquired AOS is caused by any condition that affects the structures and pathways of the brain responsible for planning and programming motor movements for speech. Unlike Developmental Verbal Dyspraxia (DVD), it is not a developmental condition present from birth. The most common causes are:

  • Stroke
  • Traumatic Brain Injury (TBI)
  • tumour
  • Surgical Trauma (e.g., tumour resection)
  • Neurodegenerative diseases (e.g., cortico-basal degeneration, progressive supranuclear palsy).

Symptoms of acquired dyspraxia are the same as those for DVD, and include:

  • Reduced overall speech rate
  • phoneme distortions and distorted substitutions, additions, or complications
  • Syllable segregation with extended intra- and inter-segmental durations
  • Equal stress across adjacent syllables.

A speech and language therapist can help people with acquired apraxia of speech with improving speech production and intelligibility and, when indicated, using AAC, helping individuals capitalise on their strengths and modifying environmental barriers to facilitate more effective communication and participation.

More information

Autism Spectrum Disorder (ASD)

This is a lifelong condition covering a whole range of social communication difficulties. Every adult with this disorder will have a slightly different presentation.

The main characteristics of this disorder are –

  • Impairment of imagination – there may be:
    • difficulties with flexible thinking
    • rigid routines and interests
    • difficulties coping with change
    • inability to generalise information.
  • Impairment in social relationships – difficulties in understanding how to relate and
    interact with other adults.
  • Impairment in social communication – difficulties in effectively communicating
    with other people.

Adults with ASD may have a mix of all three main characteristics and can also
present with a predominant deficit in one particular area. Adults with ASD may also
have other associated problems: e.g. anxiety problems, clumsiness and attention
problems, struggling to hold down a job are common in adults diagnosed with autistic
spectrum disorder.

More information

Eating, drinking and swallowing disorders / dysphagia

Eating, drinking and swallowing disorders affect the ability to safely maintain hydration and nutrition and raise the risk of chest infection, choking, and pneumonia.

There are many possible causes of eating, drinking and swallowing disorders in adults such as:

  • Acquired brain injury or stroke
  • Progressive Neurological Disorders
  • Dementia
  • Gastroenterological disorders and/ or reflux
  • Head and neck abnormalities, cancer or injury
  • Muscle weakness
  • Sensory changes / feeling of a lump in the throat
  • Side effects of medications

General Signs of Swallowing Problems:

  • Coughing or throat clearing during or right after swallowing
  • Wet or gurgly sounding voice
  • Extra time or effort needed to chew or swallow
  • Food or liquid leaking from your mouth
  • Food getting stuck in your mouth
  • Breathing difficulties after meals
  • Chestiness or wheeze
  • Frothy secretions
  • Weight loss

Speech and Language Therapists Can Help With:

  • Assessing eating and drinking during meals, looking at different patterns with different food and fluid consistencies
  • Assess the strength of the oral-facial musculature and muscles used in swallowing
  • Assess seating, positioning and trial manoeuvres and strategies aimed at relieving the swallowing difficulties
  • Refer for specialist swallowing tests such as videofluoroscopy or FEES
  • Offer therapy programmes aimed at strengthening musculature and swallowing safety
  • Modifying consistencies of fluids and / or foods to improve the safety of the swallow
  • Liaising closely with family, carers and the Multidisciplinary Team to monitor swallow safety

More information

Dysarthria

Dysarthria is a neurologically related speech disorder that is the result of injury or changes to the adult’s brain motor function area (frontal lobe) or other cranially related damage. Common causes in adulthood include: stroke, head injury or progressive conditions such as Parkinson’s.

Dysarthria usually affects motor function and results in symptoms affecting rate and quality of speech and voice. These motor function problems can also result in swallowing problems (Dysphagia). The severity of a dysarthria varies from individual to individual, ranging from very mild presentations which are almost unnoticeable to very severe difficulties controlling the muscles of the mouth.

A speech and language therapist can help an adult with dysarthria by:

  • Giving them exercises to strengthen the muscles of their mouth,
    articulation therapies.
  • Helping adults to co-ordinate their breathing for speaking more effectively.
  • Advising on appropriate forms of AAC when appropriate and necessary.
  • Providing advice and strategies for achieving and maintain a safe swallow when an adult has associate swallowing difficulties.

More information

Head and Neck Cancer

A speech and language therapist working with head and neck cancer patients will provide detailed assessment, treatment and management of communication and swallowing problems. These problems may be temporary or permanent due to effects of the tumour or the changes to anatomical structures subsequent to treatment.

The speech and language therapist will endeavour to gain an in‐depth understanding of the impact that communication and swallowing problems caused by cancer, or its treatment, has had on patients and their family.

The SLT will aim to maximise a patient’s communication and / or swallow potential and provide supportive care in order to help the patient (and family) achieve their optimum quality of life.

More information

Learning Disability

This term covers a wide range of developmental learning problems. Adults with these difficulties may be described as having global developmental delay when they are very young. This can occur on its own or with other problems such as hearing, vision or physical problems. Some adults may have profound multiple developmental difficulties, and this is means they have complex needs.

Every adult with learning disability is different.

The cause of learning disabilities may be unknown, or it may be related to a syndrome.

More information for further information

Mental Health

We all hope for good mental health: the capacity to enjoy life and cope with its challenges. Problems that affect this capacity are varied in type and severity. In some severe cases the term psychiatric illness, or mental illness, is used. Mental health problems can affect adults. Changes in communication skills, social skills, and swallowing patterns (dysphagia) are features of mental health problems that speech and language therapists may be involved with.

Some characteristics of mental health problems:

  • Inappropriate social skills e.g. reduced interaction or being extremely talkative.
  • Reduced non-verbal skills e.g. reduced eye-contact, poor posture, reduced facial expression. Memory deficits, reduced orientation. (Found predominantly in those with dementia).
  • Communication deficits affecting comprehension and expression (with inability to stick to topics of conversation).
  • Swallowing deficits (dysphagia).

Speech and language therapists are often involved with multi-professional teams working in mental health settings. The client is always under the care of a psychiatrist and may have a Care Coordinator and/or social worker in the community.

The following may form part of therapy input for people with mental health problems:

  • Informal communication assessments and writing guidelines for carers and/or other health professionals with strategies to enhance two-way conversation.
  • Informal dysphagia assessments and writing swallowing guidelines (dysphagia management).
  • Group therapy for adults: social skills groups targeting non-verbal skills (e.g. eye-contact/facial expressions), assertiveness, problem-solving, negotiation skills, ‘small talk’ and initiating conversations.
  • Group therapy for older people with dementia: groups targeting maintenance of communication skills through reminiscence/validation therapy

More information

Palliative Care

The ability to communicate ones needs, thoughts, feelings and wishes is central to a person’s sense of wellbeing and quality of life. It enables these with life limiting conditions to be active participants in goal setting within the wider rehabilitation process, expressing their needs, wishes and priorities and contributing to personalised advance care plans. When communication is compromised, significant frustration and distress can result for both the adult and their caregivers.

Speech and language therapists (SLTs) are skilled in assessing, diagnosing and advising on a wide variety of communication difficulties. Particularly when working with patients with life-limiting and rapidly progressing conditions, it is essential that intervention begins at an early stage in order to plan and prepare for any deterioration in communication abilities.

More information

Progressive Neurological Disorders including Dementia

These conditions involve a progressive deterioration in function; the speed and pattern of deterioration will vary from condition to condition and with each person affected.

They include Multiple Sclerosis, Parkinson’ s Disease, Huntington’s Disease, Motor Neurone Disease and Primary Progressive Aphasia.

Communication, voice, speech, memory and eating, drinking and swallowing disorders are common symptoms associated with Progressive Neurological Disorders and people affected benefit from early identification and management.

Dementia is also a progressive neurological disorder with a progressive loss of the powers of the brain. There are many kinds of dementia but the most common is Alzheimer’s Disease. One of the most common symptoms is memory loss, however with progression of the disease it can also affect communication and eating, drinking and swallowing.

Recognised Characteristics of Progressive Neurological Disorders

  • Slurred speech [dysarthria] – where the muscles required for speaking and breath control are affected
  • Dysphonia – voice problems
  • Dysphagia – eating, drinking and swallowing disorders including drooling
  • Cognitive Impairment – memory loss and personality changes

Speech and Language Therapists are often involved with multi professional teams working with Progressive Neurological Disorders. Communication and voice therapy should begin at the first signs of the impairment. They should continue throughout the course of the disorder depending on fatigue, and need, to maximise potential and establish appropriate forms of communication.

Early identification of eating, drinking and swallowing disorders reduces the risk of complications of choking / chest infections and helps maintain oral intake for as long as is safe and appropriate.

Speech and Language Therapy Input May Include:

  • Swallowing assessment and management advice such as food /fluid modification, postural strategies, swallowing manoeuvres, and the discussion of supportive enteral feeding
  • Exercises for the face, lips, tongue, palate and/or jaw to maintain strength and movement
  • Speech articulation programmes, rate of speech and volume
  • Voice Programmes for breath control, volume, pitch, stress and vocal tone
  • Assessment and trials with forms of Augmentative or Alternative Communication (AAC)
  • Fatigue Management
  • Conversation Practice
  • Memory support aids
  • Advice for carers

More information

Right Hemisphere Damage

The two sides of our brains are responsible for different functions. Whereas language is mostly (and usually) processed on the left-hand side, the right hand side is important for attention, memory, reasoning, and problem solving.

Right hemisphere damage may be caused by stroke, traumatic brain injury, infection or tumour.

People with right hemisphere damage may experience problems with:

  • Attention
  • Reasoning and problem solving
  • Memory
  • Social skills
  • Organisation
  • Insight
  • Everyday orientation of events.

More information

Stammering / Dysfluency

Stammering is sometimes referred to as stuttering. Speech and Language Therapists often refer to it as dysfluency. This is because the flow of speech is not fluent.

Many adults can suffer from persistent stammering from childhood, or they can acquire it later in life due to trauma.

Over time, this persistent stammering can lead to low confidence, an increase in anxiety in social situations, and avoiding speaking to others.

More information

Stroke

A stroke is a serious life-threatening medical condition that happens when the blood supply to part of the brain is cut off. The sooner a person receives treatment for a stroke, the less damage is likely to happen. There are 3 main causes of strokes:

  • Ischaemic – where the blood supply is stopped because of a blood clot, accounting for 85% of all cases
  • Haemorrhagic – where a weakened blood vessel supplying the brain bursts
  • Transient ischaemic attack (TIA), where the blood supply to the brain is temporarily interrupted. This causes what’s known as a mini-stroke. It can last a few minutes or persist up to 24 hours. TIAs should be treated urgently, as they’re often a warning sign you’re at risk of having a full stroke in the near future.

Certain conditions increase the risk of having a stroke, including:

People who survive a stroke are often left with long-term problems caused by injury to their brain. Some people need a long period of rehabilitation before they can recover their former independence, while many never fully recover and need ongoing support after their stroke.

Common speech and language conditions resulting from stroke include:

  • Aphasia
  • Apraxia of speech
  • Dysarthria
  • Dysphagia (swallowing difficulties)
  • Right Hemisphere Damage

More information

Voice Disorders

Adults present with voice problems for a variety of reasons. Adults can have voice problems due to illness, infection, trauma, surgery, shouting, screaming or talking too much.

The most common cause of voice problems in adults is that of vocal abuse – abuse of the vocal cord through a lot of talking. People who talk or sing professionally (e.g. entertainers, teachers etc) have a higher risk of developing voice problems.

Vocal abuse can lead to vocal nodules – a swelling on the vocal cords – which in turn lead to deterioration in the quality of the voice.

Not all adults with poor voice quality have vocal nodules but if vocal abuse persists then nodules may develop.

It is usual to have ENT involvement if an adult has poor voice quality. This is always the case if there is serious illness, trauma or surgery involved. In such cases, Speech and Language Therapists will be part of a multi-disciplinary team.

Once direct multi-disciplinary involvement has finished, professionals / the adult may still feel it would be beneficial to have speech and language therapy input.

In cases such as vocal abuse and misuse, some adults may choose not to have ENT involvement in the first instance and seek the advice and involvement of a Speech and language Therapist.

More information

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