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Adult comm specialist 4th October 2016 – Bindu

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)
Hi
Specialist • Tue, 19:05
think we are sotrted bindu are u here

yes and i can now relax lol

yes we are all ready bindu
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – i’ve closed the other chat
no probs
SaiPrasanna Bangera (SaiPrasanna.Bangera@integratedtreatments.co.uk, Sai.Bangera@integratedtreatments.co.uk, SaiPrassana.Bangera@integratedtreatments.org.uk, SaiPrasanna.Bangera@integratedtreatments.org.uk) – Hi Bindu

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – ok. Are there any specific question or topics that people would l ike to start with?
bindu there are a few newbies so could you just introduce yourself first
Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) -Apologies. I qualified in 2008 and have worked in various adult setting ranging from community, rehab wards and acute. Currently I work at St Mary’s Hospital in London doing 0.5 trauma rehab and 0.5 acute.
Apologies now for any typos
no probs has anyone got any specific questions for bindu?
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – Here is some recent research in aphasia. It’s very generic but may give some ideas for how to approach therapy
Brady MC, Kelly H, Godwin J, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD000425. DOI: 10.1002/14651858.CD000425.pub4.
This is a Cochrane review and it concludes that SLT for people with aphasia following stroke can lead to improved functional communication, reading, writing, and expressive language compared with no therapy. There is some indication that therapy at high intensity, high dose or over a longer period may be beneficial.

http://www.sciencedirect.com/science/article/pii/S0022510X15001513
The most important factors that determine recovery are the lesion location and size, aphasia type and severity and to some extent the nature of early haemodynamic response, and treatment received. Anagraphic factors like gender, age, handedness and education have not been found to be robust predictors of recovery.

http://www.sciencedirect.com/science/article/pii/S0003999316300740
a systematic review that says that we should do conversation partner training. I think especially in those patients who have not progressed very much with impairment based therapy.

http://www.tandfonline.com/doi/abs/10.3109/13682822.2010.484845
This study suggests that ‘typical’ naming treatments can be effective for some bilingual people with aphasia, with both L1 and L2 benefiting.
oh that is very well prepared bindu!
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – Are there any questions based on any of this? or any topic that anyone is interested in hearing about?
any new interventions bindu that are coming through that we need to be aware of?

Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – Is that the same in someone who has aphasia as a result mild cognitive impairment and not stroke.
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – Nothing new that I can think of in communication therapy.
Ali any questions????

Have you ever run groups bindu as a way of providing intervention

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – I went on a course about cognitive communication disorders earlier this year and I would be happy to email some slides regarding this
Alison Mann (alison.mann@integratedtreatments.co.uk) – I’m driving at the moment, sorry
Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – Yes that would be good

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)
Shayma- what would be the cause of the mild cognitive impairment? A traumatic brain injury or are you thinking more congenital

oh that would be interesting if you send to anna bindu then i can upload to the therapists

Elizabeth Swaniker-Noi (elizabeth.swaniker-noi@integratedtreatments.co.uk, elizabeth.swaniker-noi@integratedtreatments.co.uk, elizabeth.swaniker-noi@integratedtreatments.org.uk) – In the list of research under the first article about systematic review, I wondered what “high intensity “therapy might mean in terms of the number of sessions?
Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – My client has a history of playing rugby for most of his years, and the damage in his brain is due to this. Sorry if I am being vague, my iPad is very slow

He is now in his 80’s

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – so the review looked at 57 RCTS and the amount of therapy they offer in the studies varies. It wold be a case of having a look at the individual studies to see what they class as ‘high intensity;

In stroke rehab 3 x week is considered high intensity

it is important to look at this type of research so that we can make recommendations to clients in terms of intensity

Elizabeth Swaniker-Noi (elizabeth.swaniker-noi@integratedtreatments.co.uk, elizabeth.swaniker-noi@integratedtreatments.co.uk, elizabeth.swaniker-noi@integratedtreatments.org.uk – Will definitely read the research -thank you, very useful
Lynn CB Joyce (lynn.joyce@integratedtreatments.co.uk, lynn.joyce@integratedtreatments.org.uk, lynn.joyce@integratedtreatments.co.uk, lynn.joyce@integratedtreatments.org.uk) – How do you involve the family in the slt stroke rehab?

do you think though that the NHS can provide that intensity particuallry after discharge?
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – but intensity does not necessarily mean direct therapy. therapy with family, on an ipad or conversation partner stuff can all add to intensity
SaiPrasanna Bangera (SaiPrasanna.Bangera@integratedtreatments.co.uk, Sai.Bangera@integratedtreatments.co.uk, SaiPrassana.Bangera@integratedtreatments.org.uk, SaiPrasanna.Bangera@integratedtreatments.org.uk) – Very interesting research evidence! Thank you 🙏
Lorraine Smith (lorraine.smith@integratedtreatments.co.uk, lorraine.smith@integratedtreatments.org.uk) – in my experience when patients get home they have very little support/therapy
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)- I think with the NHS the type of intensity you would get varies so much. really depends on location.
it would be interesting to see the results if the intense was provided by just an slt V’s a mix of direct/indirect

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – I think as long as there are ‘smart goals’ for therapy even after dc from NHS then it is valid to offer therapy

Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – Ok, thanks. I have another question that you can answer after everyone else’s questions, basically my clients partner has mentioned that he isn’t asking questions, eg. In social situations, when he participates in a conversation , but only will speak about things general, but will not ask question to extend a conversation, are there ideas or article you can share with me in regards to intervention. Thanks
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – So shayma your patient with the diffuse head trauma (rugby player) sounds like he has a cognitive communication discorder

Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – He has some short term memory, but mainly word finding difficulty hence aphasia
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)- does he have any aphasic features? eg word finding

Have you done anything like the MCLA on him
Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – Yes he has been diagnosed with aphasia by another health prof. I have Boston, bdae
whats the MCLA

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – and videtaping conversation with his partner. I think the information on cognitive communicaton disorders will be very useful for him

Measure of Cognitive Linguistic abilities
Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – It mainly was, but now it’s becoming more of a social thing too as his wife has mentioned, I haven’t seen them in a month but will be seeing them next week.
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – Assessments such as the BDAE and CAT only really pick out pure language disorders.
Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – I have asked them to record a conversation, previously they didn’t do it

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – So if the main reason communication is affected is cognition then it is good to try other assessments

The Mount Wilga can be found free online if you google it. It is not standardised but very widely used to assess this type of communication disorder

I think videoing is better than just audio because the pragmatics is also likely to be affected
eg what is his eye contact like? does he know how to take conversation turns properly.

Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – It’s more aphasia than cognition Bindu

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – You can then sit with him and ask him to rate his own communication
i like the idea of videoing because it can be powerful to show strengths and difficulties

Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk,
shayma.muqtadir@integratedtreatments.org.uk) – We have good conversation together no problem. His main is word finding , but now becoming more social as he doesn’t like to talk to others because he can’t find his words

I will defrost take the video on board Bindu

Should be interesting
Alison Mann (alison.mann@integratedtreatments.co.uk) – Finished driving now. Unexpected family drama…… had to drive teenager somewhere. I’ve caught up with the conversation now.
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – As a general rule with any young man (or lady) who has a traumatic head injury, and particulalry if the injury is not focal, we should look beyond just pure language.because when they try to go back to jobs etc it will be the subtle cognitive communication issues that will be problematic

Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk – Ok
Lynn CB Joyce (lynn.joyce@integratedtreatments.co.uk, lynn.joyce@integratedtreatments.org.uk, lynn.joyce@integratedtreatments.co.uk, lynn.joyce@integratedtreatments.org.uk) – Do you use video modeling with this population?

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – Also see what his family says. There is a good questionnaire called the la Trobe which you can get the patient and family to fill out to see if they have the same thoughts about communication
Alison Mann (alison.mann@integratedtreatments.co.uk) – Wouldn’t you have a range of goals though, targeting different areas
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – I will forward it to you tomorrow (hopefully that’s not illegal because i’m not sure it’s free anymore)

modelling can be helpful too

but role-playing also- eg ask them to change a behaviour during a conversation with you or their family and film it

You would target different areas. eg You may target word-finding and also more subtle conversation behaviours

Also- with any adult patient it is really important to know what the neurology is. I think we forget this sometimes as Speech Therapists.
Alison Mann (alison.mann@integratedtreatments.co.uk) – I agree with that but find that most clients/families are very language focused. They just want to talk properly aga

SaiPrasanna Bangera (SaiPrasanna.Bangera@integratedtreatments.co.uk, Sai.Bangera@integratedtreatments.co.uk, SaiPrassana.Bangera@integratedtreatments.org.uk, SaiPrasanna.Bangera@integratedtreatments.org.uk) – One of my friends at Uni is involved in the EVA Park project. It sounds really cool!
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – We should know what brain scan findings are before we assess and we should be going into assessment with a rationale about what kind of communication disorder we might see before meeting the patient

Alison it’s interesting you say that

I think we need to help the family priortise the goals
sometimes as private therapists it is difficult to get all that information prior to goin in
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)
eg if you have a young man who has poor eye contact and turn taking that is more likely to be a problem han m ild word-finding difficulties in the big bad world
Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – The mount wilga is a very long assessment, would I do all of it with a client, or just bits that I think are relevant. ..?
but families only fous on the word-finding

I think you would do bits shayma
Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – Ok glad you said that
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)
I agree Helen but we should try our best to look at hospital letters and also get written permission from the client to call the GP.
Alison Mann (alison.mann@integratedtreatments.co.uk) – I think many families have a hierarchy of priorities and language/speaking again is always number 1

Lorraine Smith (lorraine.smith@integratedtreatments.co.uk, lorraine.smith@integratedtreatments.org.uk – I think they see it as being the biggest life changer!
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)
Yes Alison. And sometimes that is appropriate. they always want their loved one to talk.

I have had patients who quite frankly will never talk and it takes the family a while to embrace ‘total communication’ like drawing, gestures etc

families feel like therapy has failed unless the client talks fluently again
Alison Mann (alison.mann@integratedtreatments.co.u — Sometimes lack of insight from the client can be an issue too.
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)
Yes- video-recording is really useful for that. Where i work in trauma people are very acute after their head injury and actually the main thin to work on is insight

They will not be motivated without insight

you may have to set them up to fail. eg they may say they can make a phonecall- get them to do it and when they fail it may help with insight

just with recording as well- don’t forget consent

a good way around this is to record on their own phones/ipads

Alison Mann (alison.mann@integratedtreatments.co.uk)

I’ve been fortunate in the information I’ve had about my aphasia clients. I’ve had copies of reports and scans but even after a 9 month acute placement I’ll be honest I didn’t always know what they meant without considerable research.

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – That’s another reason why looking at them is good- to get familair with the terminology.

If you’re seeing an impairment that completely does not match up with the head injury then you should be writing to the GP/Neurologist and asking for a review

Alison Mann (alison.mann@integratedtreatments.co.uk) – Are you saying that having a knowledge of location of injury before ax would allow you to generate hypothesis about what to appraise

Specialists seem to use different terminology from each other
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – eg recently i had a man with a severe occipital only traumatic head injury/bleed. he was cortically blind as a result. he was also severely aphasic which did not match with the initial diagnosis. I asked for a neurology review, he had an MRI and they found left fronto-parietal lesion too- which explains the aphasia

You are right Alison

I k now everything in the brain cannot be localised but we should be able to recognise what sort of disorders we may get in a focal injury vs a contracoup injury

there are rough patters and actually it might mean that you can be more selective with assessment

Lorraine Smith (lorraine.smith@integratedtreatments.co.uk, lorraine.smith@integratedtreatments.org.u – ooh I miss neurology

Alison Mann (alison.mann@integratedtreatments.co.uk
You obviously have way more experience than me but I’ve got to the point where I always expect the unexpected with a brain injury. The brain is a marvellous and curious organ and often does things you don’t expect

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – if we say someone has a word-finding difficulty we should be able to trach back to the neurology which may explain this
Alison Mann (alison.mann@integratedtreatments.co.uk)

Okay so for example you mean basal ganglia injury expect speech problems

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk – yes

Alison Mann (alison.mann@integratedtreatments.co.uk) – Or brocade area infarct

Brocas area
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – yes- although neurologists don’t really call it broca’
Alison Mann (alison.mann@integratedtreatments.co.uk)
Predictive text

What do they call it

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – they will just name the brain area

so parietal or temporal

google is a wonderful thing! I don’t know what every brain region does but it can always be looked up!

with dysarthrias it is important to know too.

because you want to give the correct exercises depending on what the neurology is. eg knowing if a weakness is flaccid or spastic

i am not telling you anything new but it is easy to forget all of this stuff from uni and become very impairment focussed and not think about te mecahnism behind it
it is often helpful to recap

Lorraine Smith (lorraine.smith@integratedtreatments.co.uk, lorraine.smith@integratedtreatments.org.uk) – I find it fascinating… just waiting for an adult client
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – It is Lorraine. Like detective work!

Also a reminder- don’t forget the Ellis and young model either

Lorraine Smith (lorraine.smith@integratedtreatments.co.uk, lorraine.smith@integratedtreatments.org.uk) – I used to love reading through the medical notes on the acute/neurology ward and tracking it all

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)
eg word finding difficulty- is it a semantic imparment or an issue with lexicon?
Lorraine Smith (lorraine.smith@integratedtreatments.co.uk, lorraine.smith@integratedtreatments.org.uk) – Ellis and Young model…. *quickly googles
any further questions for bindu
Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)

eg Shayma your patient. is your therapy sematic focussed or based on accessing an intact semantic system
Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – Accessing an intact semantic system,

More lexicon based

He knows his words and categories, just find it difficult to access them

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk
great- so he has all the words but can’t retreive them. pyramids and palm trees (or just checking informally) will tell you whether semantics is intact

Elizabeth Swaniker-Noi (elizabeth.swaniker-noi@integratedtreatments.co.uk, elizabeth.swaniker-noi@integratedtreatments.co.uk, elizabeth.swaniker-noi@integratedtreatments.org.uk) – No questions from me but great to revisit and love the recent research links – thank

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) yep- Systematic reviews are good. they read lots of papers for you and give you a conclusion!

Fab thanks everyone for all the questions and comments x x I have a busy day answering all your emails tomorrow x x

Fatima Bibi Seedat (fatima.seedat@integratedtreatments.co.uk, fatima.seedat@integratedtreatments.co.uk, fatima.seedat@integratedtreatments.org.uk)
Thanks Bindu, I’m looking forward to an adult client…bringing back memories of uni

SaiPrasanna Bangera (SaiPrasanna.Bangera@integratedtreatments.co.uk, Sai.Bangera@integratedtreatments.co.uk, SaiPrassana.Bangera@integratedtreatments.org.uk, SaiPrasanna.Bangera@integratedtreatments.org.uk) – Thank you

Lynn CB Joyce (lynn.joyce@integratedtreatments.co.uk, lynn.joyce@integratedtreatments.org.uk, lynn.joyce@integratedtreatments.co.uk, lynn.joyce@integratedtreatments.org.uk – Thank you for the information Bindu.

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)
please email me with any questions- i don’t mind at all

Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – Ok this has been really informative. Thank you Bindu

Alison Mann (alison.mann@integratedtreatments.co.uk) – Thanks Bindu

Lorraine Smith (lorraine.smith@integratedtreatments.co.uk, lorraine.smith@integratedtreatments.org.uk) – Thank you Bindu – great info… ☺

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk) – I will email the la trobe and the slide on cognitive communiction disorder
Shayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – Do,we have your email address

Specialist Mentor2 (specialistmentor2@integratedtreatments.co.uk, specialistmentor2@integratedtreatments.org.uk)
binduvekaria@yahoo.co.uk

hayma Muqtadir (shayma.muqtadir@integratedtreatments.co.uk, shayma.muqtadir@integratedtreatments.org.uk) – Great thanks again x