TBI & Degenerative
Conditions
Traumatic Brain Injury (TBI)
• http://www.youtube.com/watch?v=c-W_o-pMDXQ
TBI
• TBI affects 186,000 people per year (Headway 2009)
• TBI can affect all areas of life
• TBI can affect: learning ability, attention, memory,
language, voice, fluency, speech and swallowing
• Cognitive-communication disorders: cognitive difficulties
and their effect on language processing, language use
and communication behaviour (RCSLT, 2006)
• TBI can greatly impact on an individuals social
communication and therefore effect relationships
‘Don’t cut me out!’
• Access to vital support services is being reduced due to funding cuts
• “…making it harder for brain injury survivors to access the help and
support they need...lead independent lives ”. Communications Manager at
Headway
SLT value
• Early assessment in the acute setting to enable early identification of
intervention for communication and swallowing needs
• Goal orientated rehabilitation by a coordinated interdisciplinary
team
• Well planned and flexible discharge to community living to improve
longer term outcome and self management (RCSLT, 2006)
The National Service
Framework for long term
neurological conditions.
(March, 2005)
• To improve the treatment and long term support of people with
neurological conditions by 2015.
• 11 quality standards - health and social care
•
•
•
•
3 qualities most relevant to individuals with TBI (Headway)
- person-centred service
- community rehabilitation and support
- supporting families and carers
Dementia
• Approximately 800,000 people are diagnosed with the
condition today
• Prediction:
- increase to 1 million by 2021
- 1.7 million by 2051
1 in 25 over 65
1 in 6 over 80
Only 43% receive diagnosis
(Alzheimer’s Society 2014)
Dementia
• http://www.telegraph.co.uk/health/10511920/A-cure-fordementia-could-be-found-within-twelve-years-DavidCameron-has-said.html
Dementia
80% of people living in care homes have a form of
dementia (Alzheimer’s Society 2013)
Global action – there is “no solution to the
dementia crisis without research” (G8 summit)
Carers are vitally important (NICE) – funding is
needed to adapt care homes, train carers and
adapt wards to be facilitating communication
(Defeating dementia campaign)
Communication is key
• For individuals to maintain a quality of life – communication is
important
• The RCSLT Dementia Campaign:
• Early intervention to monitor changes over time
• Help relatives and carers communicate with individuals with
dementia more successfully and for longer
• Funding will allow training days to be set up to train
individuals in communication strategies
• Feeding assessments – allow them to keep their
independence concerning eating and drinking
Parkinson’s Disease
• 1 in 500 people suffer with Parkinson’s disease
• 127,000 currently have Parkinson’s in the UK
• Stem cell research – working towards a cure – new funding
March 2014 (Britain and Israel)
• Palliative care needed at all phases of the condition
(Parkinson’s UK 2013)
• 90% of individuals with diagnosed Parkinson’s experience
dissatisfaction with how they communicate (Miller, et al,
2010)
Parkinson’s Disease
• Lee Silverman Voice Therapy has been shown to be effective
in improving communication in individuals with the condition
• The majority of individuals with Parkinson’s found SLT had a
positive effect, helping breathing, speech rate, loudness and
confidence, as well as strategies to help swallowing (Miller, et
al, 2010)
Motor Neurone Disease
• Majority of people aged 50-70 years
• Incidence – 2 people in every 100, 000
• Prevalence – 7 people in every 100,000
(MNDA 2014)
• Incidence of motor neurone disease is increasing
as people live longer and more accurate
diagnosis
• No cure – manage symptoms to improve quality
of life
Motor neurone disease
• Standards of care developed by MND association – work
together to maintain these standards
• MND Year of Care Pathway to help the NHS and Social Services
improve the provision of services for people with MND
• SLT input – dysphagia and dysarthria – important for
individuals to still be able to communicate with friends and
family
(Resource manual for commissioning and planning services for
SLCN– dysarthria, RCSLT 2009)
Multiple Sclerosis (MS)
• 20-50 years old
• Incidence: 4 per 100,000 (MS Society 2006, cited in RCSLT
2006)
• Prevalence: 144 per 100,000 (MS Society 2006, cited in RCSLT
2006 )
MS
Challenges as an organisation and SLT clinician
• variable condition:
Relapse/ remission
Slow progressive increase in symptoms.
• Prognosis unpredictable
• SLT role in rehabilitation (NSF)
A case for speech and language
therapy and MS
• ‘Key element of successful home care’ (The National Service Framework for Long-term
Conditions, 2005. Department of Health)
Recommendations (NICE Guidelines on MS):
• Dysphagia
• Communication:
Dysarthria
AAC
Advice and training for circle of support
LOCAL IMPLEMENTATION POINTS:
• which speech and language therapist should see people with dysarthria
• who may assess for and recommend augmentative equipment and adaptive technology to
• communication
• funding arrangements for augmentative aids to communication (AACs).
We need your funding!!
Useful links
• https://www.headway.org.uk/home.aspx
• https://www.headway.org.uk/news/dont-cut-me-out.aspx
• https://www.gov.uk/government/publications/qualitystandards-for-supporting-people-with-long-term-conditions
• http://www.alzheimers.org.uk/
• http://www.rcslt.org/governments/docs/dementiacampaign_
bulletinmay2013
• http://www.mssociety.org.uk/sites/default/files/Documents/
Governance%20docs/Misc%20resources/Annual%20report%2
0and%20accounts%202006.pdf
• http://www.rcslt.org/docs/freepub/TBI_reading_list_Feb_07__2_.pdf
• http://www.nice.org.uk/
References
• Miller, N., Noble, E., Jones, D., Deane, K. H. O., Gibb, C. (2010). Survey of speech
and language therapy provision for people with Parkinson’s disease in the United
Kingdom: patients’ and carers’ perspectives. International Journal of Language
and Communication Disorders, Online 23 June 2010
• Motor neurone disease association (2014). Brief guide to MND. Retrieved March
17th, from http://www.mndassociation.org/what-ismnd/Brief+guide+to+MND.htm
• Parkinson’s UK (2013). NICE guidelines for Parkinson’s. Retrieved March, 12,
2014, from http://www.parkinsons.org.uk/content/nice-guideline-parkinsons
• RCSLT (2006). Communicating quality 3. London: RCSLT.
• RCSLT (2009). RCSLT resource manual for commissioning and planning services
for SLCN; dysarthria. Retrieved 14th March, 2014, from
http://www.rcslt.org/speech_and_language_therapy/commissioning/dysarthria
_plus_intro
• RCSLT (2009). RCSLT resource manual for commissioning and planning services
for SLCN; TBI.
http://www.rcslt.org/speech_and_language_therapy/commissioning/brain_injur
y_intro
• http://www.nice.org.uk/nicemedia/live/14355/66330/66330.pdf