● Equality Act (2010)
● Mental Capacity Act (2005)
● Health and Social Care Act (2012)
● Putting People First (2007)
● Headway
● Alzheimer’s society
● MND association
● Parkinson’s UK
● National Multiple Sclerosis Society
● RCSLT commissioning and planning services for SLCN Brain Injury (2010)
● RCSLT commissioning and planning services for Dementia (2013)
● RCSLT dementia position paper (2014)
● RCSLT clinical guidelines
● NICE/SIGN clinical guidelines

Head injury
These indicate traumatic brain injury, ranging from minor brain injuries to severe injuries causing long-term disability.
● 213,752 = Total UK admissions to hospital for head injury in 2011-12 (169,673 non-superficial)
● 10-20,000 = number of severe traumatic brain injuries per year in the UK
● 33.5% = Increase in UK head injury admissions in the last decade
● Most at risk of TBI = 15-24 year old males & over 80 year olds
Effects
● Behaviour and personality
● Anxiety, depression, loss of motivation, difficulty controlling anger, and impulsivity
● Cognitive
● Problems with memory, attention and concentration, low tolerance of noisy or stressful environments, loss of insight and initiative
● Physical

● Working with individual and family
● Reducing barriers relating to:
○ social participation
○ education
○ work
● Provide AAC where appropriate
● Dysphagia treatment
RCSLT, 2010
Brain injury is BIG.

there are actually a lot of studies which support the importance of SLT in TBI cases, e.g.:
● Togher et al. (2010) - training communicative partners has a positive effect
● Behn et al. (2010) - communication training for care-givers improves conversational interactions
● Rosenvinge and Starke (2005) - Advice and guidance from SLTs enhances adherence to swallowing regimes
● Galski (1998), Dahlberg et al (1998), McDonald (2008) - developing social communication can have a positive outcome which can help individuals cope in society.

● Epilepsy
● Parkinson's Disease
● Huntington's Disease… etc...
● Motor Neurone Disease
● Multiple Sclerosis
● Dementia

• Importance of Communication: Many describe losing their voice as being devastating, puts them at risk of social isolation.
• “Condemned to Silence” All Party Parliamentary Group
(APPG) report (January 2015) Inquiry into the access to communication support for people with MND

• AAC provision as an urgent priority
• NHS should investigate options for establishing ‘loan banks’ of high tech AAC devices
• AAC provision closely integrated with environmental control, wheelchair and computer provision.
• Consistent training for communication aids
• Prioritising people with MND for anticipatory SLT assessments
• Research into the potential benefits of eye gaze technology for people with MND

There are approximately 107,000 people with MS in the UK, and each year 5,000 people are newly diagnosed with the condition.
This means that around one in every 600 people in the UK has MS, and that each day, 14 people are diagnosed with MS.
(MS Society)
40-50% of this population experience speech problems (approximately 50,000 people in the UK!)
⅓ experience dysphagia (approximately 36,000!)
Multiple sclerosis is one of the most common neurological conditions among young adults (NHS Choices, 2014) and is the most common cause of serious physical disability in adults of working age. (NICE, 2014)
(MS Society)
The course of the disorder is unpredictable, and can include frequent relapses/remissions (RCSLT, CQ3)

‘These things [speech difficulties] happen especially when I am in a noisy or busy place or with more than one person there, for example going for a meal with several people. I often don't go, because I find things hard.’
‘I have experienced speech difficulties during relapses and it made me feel very awkward, embarrassed and sensitive to who I would speak to and their view of me.’
SLT Value in progressive neurological disorders = the promotion and maintenance of independence and an acceptable quality of life (RCSLT, CQ3)
SLTs should be part of the multidisciplinary team of professionals involved in the care of individuals with MS
(NICE, 2014)

Effects of Dementia:
•
Memory loss, Aphasia, Apraxia, Agnosia, Disturbances in executive functioning...
• Communication difficulty for the person with dementia and their carer.
• Eating, drinking and swallowing difficulties. (NHS, 2013;
RCLST, 2014)
SLTs have specialist knowledge to assess and manage these effects.
Alzheimer’s UK Statistics:
• 800,000 people in UK have dementia → expected to rise over 1 million by 2021 . (2013a)
• One third of people over 65 will have dementia by the time they die. (2012)
• One quarter of hospital beds and up to 70% of places in care homes are occupied by people with Dementia. (2014)
•
Dementia costs the UK more than
£23 billion in 2012
(2012)
→ expected to rise to over £50 billion (Comas-Herrera et al, 2007)
Demand for services is increasing, but spending on care in parts of the UK is decreasing
(ADASS, 2014).

National Dementia Strategy (Department of Health, 2009)
Was a 5 year plan by with three strategies of:
•
Ensure better knowledge about dementia and remove the stigma
• Ensure early diagnosis, support and treatment
• Develop services to support changing needs better
Prime Minister Challenge (2012)
• Give a boost in dementia research
• Address quality of dementia care
• Increase people’s understanding of dementia
• Make communities more dementia friendly
– This government commitment ended March 2015. Depending on the next government will affect the future progress of dementia funding and awareness.
Alzheimer’s Society Dementia Friends Campaign
Their goal is to increase awareness of dementia and improve attitudes towards the disease by creating a dementia-friendly society.
RCSLT Dementia Campaign

SLTs can help with:
•
Early diagnosis (therefore early intervention ) and ongoing monitoring of changes.
• Assessment of capacity e.g. to consent to treatment or take part in care decisions .
• Maximising an individual’s function and sense of identity .
•
Safe eating and drinking and reduced risk of malnutrition, choking, or pneumonia
• Reducing stress on caregivers .
•
Training health and social care professionals to manage communication and swallowing problems to improve quality of life and independence.
• Supporting families and wider teams in managing end of life issues.
•
Maintaining interpersonal relationships between individuals and family/ caregivers and enhancing the communication environment.
(Bulletin, 2013; RCSLT Position Paper,

Effects on people with dementia
● Decreased quality of life , well being, sense of personhood & quality of relationships for both people with dementia and their carers.
●
Delay in diagnosis and/or incorrect diagnosis.
● Barriers to accessing & communicating with other professionals.
● Social exclusion.
●
Increased level of dependence at an earlier stage.
● Avoidable death due to malnutrition, choking and aspiration pneumonia.
● Exclusion from decision making and service planning.
Effects on organisations
● Unnecessary admission and readmission to hospital and residential/nursing care
● Challenging behaviour not managed effectively
● Needs of vulnerable adults not met
● Perpetuation of the current postcode lottery re access to
SLT services
● Perpetuation of inappropriate/ harmful practice

http://www.theguardian.com/society/2014/may/13/ terry-pratchett-those-with-dementia-help-from-friends
Last year, Terry Pratchett described people with dementia as "a group of people who have been side-lined and ignored for far too long."
This side-lining must end.
For the needs of people with dementia must be met, their speech and language therapy provision must be better funded.

• A law to end discrimination of all kinds….
• Applies to everyone who provides a service to the public (SLTs!)
• Protects individuals with a disability
• Defines disability by ability to carry out day to day activities, which are clearly affected by difficulties in communication
• We are legally required to ensure individuals with degenerative diseases and TBI achieve and maintain equality.

• Individuals with TBI or degenerative diseases such as dementia may have an impaired ability to make decisions
• Provides legal principles about how individuals can be supported to make decisions and sets out rules for those who take decisions on their behalf
• Includes financial affairs, property, health and personal welfare
• “Only after all practical steps have been taken to help a person make their
own decision, should they be treated as incapable of doing so”

• Extensive reorganisation of the NHS
• A main aim of the act is to “improve patient voice”
• Attempts to give patients more choice over the services they access
• Aims to reduce NHS administration costs, supporting this can only be good for all those involved with NHS care!

People, irrespective of illness or disability, should be supported to:
● Live independently;
● Stay healthy and recover quickly from illness;
● Exercise maximum control over their own life and where appropriate the lives of their family members;
● Sustain a family unit which avoids children being required to take on inappropriate caring roles;
● Participate as active and equal citizens , both economically and socially;
● Have the best possible quality of life , irrespective of illness or disability;
● Retain maximum dignity and respect .

Adass (2014). Adult social care funding: 2014 state of the nation report. London: Local Government Association.
All Party Parliamentary Group on Motor Neurone Disease. (2015). Condemned to Silence: inquiry into access to communication support for people with MND. Retrieved 05 Aprile, 2015, from http://www.mndassociation.org/Resources/MNDA/Campaigns/Documents/appg-report-final.pdf
Alzheimer’s Research UK. (2012). Facts and stats. Retrieved 08 April, 2015, from http://www.alzheimersresearchuk.org/about-dementia/facts-stats/
Alzheimer’s Society (2015). Dementia Friends. Retrieved 08 April, 2015, from https://www.dementiafriends.org.uk/
Behn, N., Togher, L. & Power, E. 2010. Improving the communication skills of paid caregivers of people with traumatic brain injury (TBI): an RCT. International Brain Injury Association’s Eighth World Congress on Brain Injury, Brain Injury ,
24 , 3, 274.
Brain Injury is BIG. (n.d.). Speech and Language SLT. Retrieved 9th April, 2015, from http://www.braininjuryisbig.org.uk/speech-language-slt.aspx

Dahlberg, C., Cusick, C., Hawley, L., Newman, J., Morey, C., Harrison-Felix, C., Whiteneck, G. 2007. Treatment efficacy of social communication skills training after traumatic brain injury: a randomized treatment and deferred treatment controlled trial. Archives of Physical Medicine & Rehabilitation , 88 , 12, 1561-1573.
Department of Health (2009). Living well with Dementia: a national dementia strategy. London: Department of Health
Department of Health (2012).
Prime Minister’s Challenge of dementia.
London: Department of Health.
Galski, T., Tompkins, C., Johnston, M. 1998. Competence in discourse as a measure of social integration and quality of life in persons with traumatic brain injury Brain Injury, 12 , 9, 769-782.
Great Britain. (2005). Mental Capacity Act 2005 . Chapter 9.London: HMSO.
Great Britain. (2010). Equality Act 2010 . Chapter 15. London: HMSO.
Great Britain. (2012). Health and Social Care Act 2012 . Chapter 7. London: HMSO.

Headway. (2015). Key Facts and Statistics.
Retrieved 03 April, 2015, from https://www.headway.org.uk/key-facts-andstatistics.aspx
McDonald,S., Tate,R., Togher,L., Bornhofen,C., Long,E., Gertler,P. and Bowen,R.: 2008, 'Social skills treatment for people with severe, chronic acquired brain injuries : a multicenter trial', Archives of Physical Medicine & Rehabilitation.
89, 1648-1659.
MS Society. (2015). MS in the UK. Retrieved 7th April, 2015, from http://www.mssociety.org.uk/sites/default/files/MS%20in%20the%20UK.pdf
National Health Service (2013). About Dementia. Retrieved 08 April, 2015, from http://www.nhs.uk/Conditions/dementia-guide/Pages/about-dementia.aspx
NHS Choices. (2014). Multiple Sclerosis. Retrieved 7th April, 2015, from http://www.nhs.uk/Conditions/Multiplesclerosis/Pages/Introduction.aspx
NICE. (2014). Information for the public: Multiple Sclerosis. Retrieved 7th April, from http://www.nice.org.uk/guidance/cg186/resources/information-for-the-public-multiple-sclerosis-pdf

RCSLT. (2006). Communication quality 3 . London: RCSLT
RCSLT. (2010). Resource Manual for Commissioning and Planning Services for SLCN: Brain Injury. Retrieved April 03,
2015, from http://www.rcslt.org/speech_and_language_therapy/commissioning/brain_injury_intro
Rosenvinge, S. & Starke, I. 2005. Improving care for patients with dysphagia, Age and Ageing , 34 , 6, 587-593
Royal College of Speech and Language Therapy Bulletin (2013).
It’s time to talk about Dementia. OR
Moser, C
(2013).
It’s time to talk about Dementia.
Bulletin, May 2013 pp13-15.
Royal College of Speech and Language Therapy. (2013) Dementia [Electronic version]. RCSLT Resource manual for commissioning and planning services for SLCN.
Togher, L., Power, E., Tate, R., McDonald, S., Rietdijk, R. 2010. Measuring the social interactions of people with traumatic brain injury and their communication partners: The adapted Kagan scales. Aphasiology , First published on:
03 February 2010 (iFirst).