Therapy

Through the adoption of a range of diverse and accessible means, Speech Therapy Interactive is supporting people with communication, cognitive and swallowing difficulties to recover vital skills. Here, Tina Kad and Marjana Akhtar explain more

Who is Speech Therapy Interactive?

We are Speech Therapy Interactive – an independent, award-winning speech and language therapy practice. We provide assessment and therapy for adults with speech, language, communication, cognitive and swallowing difficulties, as a result of neurological conditions (e.g., stroke, brain injury, dementia etc) in the Essex and East London region.

Background – how was Speech Therapy Interactive born?

After 10+ years of working within the NHS, our founder, Tina Kad decided it was time to venture out and work for her own private practice. She had just given birth to a baby in lockdown and decided the best path for her to be able to juggle her life as a new mother and still continue with her career is being able to work for herself.

‘’Speech Therapy Interactive allows me flexibility and quality time with my son (my Drive and my Why), creativity in my profession and a choice of providing quality client centred therapy.’’

Speech Therapy Interactive is approaching its second year anniversary and is expanding! In October 2022, we hired our first apprentice in collaboration with the University of Essex. Our apprentice, Marjana Akthar, is amongst the first cohort to be enrolled for the Speech and Language Therapy apprenticeship program.

What do we offer?

We offer a variety of services for adult patients, including:

• Speech therapy assessments and differential diagnosis
• Face to face therapy
• Teletherapy – online speech therapy
• Assist in mental capacity assessments
• Speech Therapy clinical supervision for students and NQP’s
• Speech Therapy education and training for healthcare professionals
• Speech therapy services in English, Hindi, Urdu and Punjabi.

A closer look into our services…

As mentioned previously, we work with adults with acquired and progressive neurological conditions such as stroke, brain injury, dementia and so forth, who have been diagnosed with the following conditions:

1. Dysphasia

Dysphasia/aphasia is a complex language and communication disorder resulting from damage to the language centres of the brain, typically the left side of the brain. This damage may be caused by a stroke, a head injury, a brain tumour or another neurological condition. This causes difficulty with: speaking (expressive aphasia), understanding speech (receptive aphasia), reading, writing, using numbers, dealing with money and telling the time.

Global Aphasia:  Severe difficulty with understanding and producing language

Broca’s Aphasia: Difficulty producing language with relatively strong understanding

Wernicke’s Aphasia: Difficulty understanding with effortless, and error filled speech.

Symptoms include:

• Difficulty understanding what people say
• Difficulty understanding written words and meaning of things
• Difficulty communicating thoughts, ideas and messages to others
• Difficulty finding the right word when speaking or writing
• Eliciting non-words (neologisms)

We take a close look at your language, understanding of words, reading and writing to find out your areas of strength and difficulty. We help you find useful and effective ways to communicate with your family and hospital staff. We provide therapy to improve your speaking, understanding of words, reading and writing.

Apraxia (of speech)

Apraxia of speech is difficulty with planning, organising and sequencing speech movements. It is when you can’t move the muscles in your face, mouth and throats in the right order to produce speech but might be able to move the muscles in insolation. This may make it difficult for you to speak and for others to understand you.

Symptoms include:

• Not being able to say words clearly, especially when someone asks you to
• Speech changes and words sound different every time you say them
• You try to self-correct errors in speech as you are aware of them.
• You hesitate between words
• You make several attempts to get the right mouth shape to say a word (articulatory groping)
• You are able to say things clearly when you recite them in a list (like days of the week or numbers), but not when you’re asked to say them on their own (automatic speech)
• Not being able to speak at all sometimes.

Following assessment, the speech and language therapist will assess the nature of your apraxia of speech. You will be provided with a therapy programme specific to your needs. Therapy may focus on a) Strategies to overcome difficulties b) Activities to reduce impairment c) Overcoming impact of apraxia of speech on your lifestyle using AAC.

Dysarthria

Often referred to as slurred speech. Dysarthria is an acquired speech disorder following a stroke and other forms of neurological injuries. It is a physical speech difficulty, due to weak, imprecise, slow and/or uncoordinated control of the muscles used for speech. This includes muscles in our face, mouth, throat as well as our breathing.

Symptoms include:

• Speech sounds slurred making it difficult for others to understand
• Words may sound like they are running into each other
• Voice may sound hoarse.
• Difficulties controlling loudness of their voice (too soft/too loud)
• Difficulties controlling rate of their speech
• Speech may sound better when saying single words or short phrases
• Lack of intonation/inflection in speech

Therapy may include exercises to improve:

• Oro-motor exercises
• Diaphragmatic breathing exercises focusing on breath control and volume
• Articulation
• Speech intelligibility in conversation using strategies to increase the speech clarity.

Dysphagia

Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others can’t swallow at all. If you have an unsafe swallow, you can be at a risk of aspiration (this means food and drink going down the wrong way into your windpipe rather than your food pipe). This can give you a chest infection which can be fatal.

• Unable to or difficulty swallow
• Having pain while swallowing
• Coughing or choking when eating or drinking
• Bringing food back up, sometimes through the nose
• Persistent drooling of saliva
• Unable to chew food properly
• ‘Gurgly’ wet sounding voice when eating or drinking
• Having to cut food into smaller pieces/avoiding certain foods because of trouble swallowing⠀⠀
• Over time, dysphagia can also cause symptoms such as weight loss and repeated chest infections.

Speech therapists would help by carrying out swallow rehabilitation exercises, providing education re: compensatory strategies to facilitate safe swallow, modifying patients diets/fluids as well as exploring alternative ways of feeding to ensure the patients are meeting their nutrition, hydration needs as well as improving the patients quality of life.

Cognitive communication disorders

Cognitive communication disorders can be a difficulty with any aspect of communication that is affected by disruption of cognition (making sense of the word through understanding, organising, interpreting and storing). Some examples of cognitive processes include thinking, attention, memory, organisation, problem solving/reasoning, executive functions and social skills.

Symptoms include:

• Difficulty with attention – trying to concentrate and staying focused on task, difficulties with alternating or divided attention
• Difficulty with memory – working memory, short term, long term
• Difficulty with planning, sequencing and problem-solving
• Difficulty with multi-tasking
• Reduced social communication skills and acknowledging social cues – interrupting conversations.
• Reduced insight into their difficulties

Cognitive rehabilitation therapy – we can provide treatment to help with memory, attention, planning and problem solving. A part of therapy is sharing strategies to manage these difficulties such as creating memory books, target executive functioning skills, and help them establish a routine/schedule to help with cognitive processing, reintegrating the patient back into the community focusing on impairment and functional based therapy.

So what do we do to help with these conditions?

Speech Therapy Interactive provides detailed assessments and diagnosis for individuals with any of these conditions and follows up with quality care through therapy plans and sessions to target specific areas. Our approach to providing therapy is through a holistic perspective and is very much person-centred. We believe in shaping our sessions around what the individual’s aims and goals, whether that is to be able to communicate with your friends again, continue with your hobbies, and regain your independence. We also aim to involve family members and loved ones and share strategies for better outcomes.

Our aim is to make Speech Therapy services more inclusive of our diverse communities!

As a speech and language therapist working within the NHS in hospital settings, Tina took on the role of an interpreter for patients who were not able to communicate in English with other healthcare professionals. Tina expressed that on the days she was not available, there were cases where there would be a barrier to communication, or misunderstandings rising from language barriers between the patient and healthcare professions. This made her realise the importance of having the availability of multilingual, multi-cultural resources to not only help the patient, but also better equip healthcare professionals so they have the ability to provide care and treatment.

The resources that we have created/are in the process of creating:

We created the following multilingual and multi-cultural resources to allow make our assessment and therapy services accessible to the South-Asian community:

• Picture Description Tasks using South Asian illustrations
• Communication Aids in Hindi, Urdu and Punjabi.
• Flashcards (nouns and verbs) in Hindi, Urdu and Punjabi.

At Speech Therapy Interactive, we believe continuously developing ourselves as therapists, through our service and our provision of more inclusive therapy and assessment tools, is KEY to making this profession better. We would not only like to increase the cultural competence of the existing demographic of speech and language therapists, but also promote it and encourage more prospective students from all walks of life to pursue this as a career: Diversifying the profession so the face of Speech and Language Therapy reflects our beautifully diverse society!

The Benefits of Picture Description tasks for Assessment and Therapy for Adults with communication and cognitive difficulties.

What are Picture Description Tasks?

Picture description tasks (PDT) are tools that are used by speech and language therapists to help them conduct an informal assessment of a potential patient who may have communication difficulties due to different speech/language/ cognitive and communication disorders. (Zingeser & Berndt, 1990). They can be used by patients of all ages, ranging from toddlers to senior citizens.  They can also be used within therapy sessions.

They consist of different scenarios or picture scenes of various situations represented in a visual pictorial form. This could be either animated or a photograph of a real-life scenario. The pictures can range from a simple picture of a shop to something as complex as a crowded grocery store, where the patient would be asked to name objects or name actions they see. Cooper (1990) states that picture description tasks provide a ‘standardised approach to language sampling.’ Because the use of picture scenes are open-ended and versatile, it opens a window of opportunities for the patient to express what they see and challenges them to use various skills such as visual, comprehension, and language skills. This consequently targets various aspects of their speech-language and cognitive-linguistic skills. In the following paragraph, we discuss in detail all aspects of the language, comprehension and cognitive skills that PDT targets specifically within the context of an adult patient accessing SLT services, and how a lot of these can interlink.

What can they be used for?

• Aphasia
• Apraxia
• Dysarthria
• Cognitive communication disorders

What do PDT Target?

• Vocabulary
• Verbs
• Nouns/pronouns
• Prepositions
• Adjectives
• Sentence formation
• WH-Questioning
• Following directions
• Narrations
• Conversations
• Memory and attention
• Inferencing, reasoning and problem solving
• Speech intelligibility and fluency

Why do we need culturally diverse resources?

• Using standardised assessments is limited.
• Increase cultural competency of speech and language therapists.
• Cultural relevance in assessment and therapy
• The importance of respecting culture and identity
•  Misconceptions on bilingualism/multilingualism

Hindi, Urdu and Punjabi speakers in the UK

The statistics show that after English and Polish, the third largest population of the UK speaks Punjabi (Pert & Bradley, 2018; Census, 2011). There is a large demographic of South Asians residing in the UK, and amongst them, the most common languages spoken include Hindi/Urdu and Punjabi. Thus, the need for culturally and linguistically appropriate resources are vital for individuals within the South Asian community who need access to SLT services for assessment and therapy.

Strokes are the leading cause of speech, language and communication disorders and research has shown that individuals from an ethnic minority background are more susceptible to suffering from a stroke (Sheikh et al, 2019). Despite this reality, there is a vast disparity of culturally appropriate resources in the UK for assessment and therapy in speech therapy. These resources are a starting point to cater for a community that is not currently being catered for in the most effective way possible.

Informal study

We conducted an informal study to test the following hypothesis: the use of culturally appropriate resources within the speech and language therapy profession has an impact on the assessment and progress of ethnic minority clients. The focus group consisted of a total of 15 South- Asians aged 65-85 with a mixture of both males and females. All participants that were chosen had no speech or language needs/difficulties.

The results indicate that when resources are culturally appropriate, individuals from that respective background are more likely to engage and elicit better speech and language in comparison to the one to which they couldn’t relate (Christmas).

What are the benefits of having diverse, multilingual resources?

• Inclusivity – individuals who speak Hindi, Urdu or Punjabi as a first language will be able to overcome the communication barrier of speaking a language other than English. Being able to communicate in their own language will give them more confidence to share their preferences and decide for themselves. It will encourage them to engage in conversation, thus improving their communication skills.

• Cultural competence tool for healthcare professionals – Due to the English translation provided with Hindi/Urdu/Punjabi, this allows healthcare professionals to communicate and understand their patients of multilingual backgrounds, if there is no availability of a translator/ interpreter. This means being able to communicate instantly.

• Celebrating diversity – diverse resources such as these do not only assist both the patient and the healthcare professional in communication, but it also unites us in our diversity and celebrates our multilingual, multicultural society.

About our resource

The PDT assessment contains 17 illustrations of culturally and religiously diverse festivals and scenarios.

1. Diwali
2. Raksha Bandhan
3. Holi
4. Karvachauth
5. Navratri
6. Vaisakhi
7. Eid
8. Ramadhan
9. Mandir/temple
10. Masjid/Mosque
11. Gurdwara
12. Grocery shopping
13. Home scene
14. Bank
15. Indian goodbye
16. Bus stop
17. Tailor

These illustrations can be used to elicit conversation: Describe, Define, Remember, Decide, Feel, Infer, Predict, Narrate, Evaluate and Brainstorm, which works on all the areas of language, grammar mentioned above.