Time to Talk Day - Neuro OT and speech & language therapy
Are we rubbing SALT into the wounds of brain injury survivors who have speech problems on Time to Talk Day - and if not, why not?
Speech and language therapists (SALTs) often work in sync with neuro occupational therapists (neuro OTs) to help give voice to huge numbers of people around the UK whose ability to communicate has been impaired by brain injury. [1]
On-Time to Talk Day today (4 February 2021) - when the nation is being urged to start even small conversations about mental health [2] - we look at the work being done by these two professional health allies to aid brain injury survivors with their self-expression.
No two clients are ever the same. They all have different situations and identities and stories to tell. 
Liz Williamson, The Speech Group
Liz Williamson recalls working with many brain injury survivors with communication disorders during her 29-years as a speech and language therapist in acute care, rehabilitation and work settings.
“These clients can have significant difficulties with planning, organisation and other executive dysfunctions,” she explains.
“Often, they have support workers, and we need to ensure that the support workers are trained in fully understanding the cognitive difficulties of the client and adjusting their own communication and management to ensure that daily activities are therapeutically challenging.
“It’s a fine balance of being supportive yet challenging the client safely and reassuringly.”
Liz, founder and director of UK-wide The Speech Group, also recalls closely collaborating with occupational therapists to share, facilitate or utilise complementary therapy practices.
Working with occupational therapy colleagues is vital in achieving a rehabilitation plan which is both value-based and client-centred.
She added: “I worked with an occupational therapist with a young man who had subtle executive difficulties. I learned so much from her.”
An occupational therapy assessment of the client’s self-awareness and insight [3] had proven particularly beneficial.
“We used this tool to drive a joint therapeutic plan,” Liz said. “It was extremely successful in achieving our aims.
“I have used this experience to add to my own toolkit of therapy resources. It was such a positive experience for all. I think we can always learn so much from our colleagues.”
The interdisciplinary approach is unavoidable, given that so many of the focus areas of neuro occupational therapy and speech and language therapy are shared, including:
- Executive function [4]
- Cognitive skills
- Sensory integration
- Posture
- Feeding
- Swallowing
- Jaw stability
Within the more holistic scope of occupational therapy, SALT and OT practises also overlap in such ways as:
- Reducing barriers to participation in activities of daily living (ADLs)
- Teaching techniques to retrain muscles used in speech
- Employing compensatory strategies: alphabet boards; picture charts; and electronic devices [5]
- Educating family and other support team members
- Providing planned, goal-oriented rehabilitation
- Working in an interdisciplinary team
And both allied health professions (AHPs) are equally intent on curating solid, scientifically based banks of evidence to ensure effectiveness and on-going improvement into the future. [6] [7]
Evidence such as that provided in a 2016 Cochrane review of the effectiveness of speech and language therapy for post-stroke aphasia [8] in which it was shown to improve:
- Functional communication
- Expressive language
- Writing
- Reading
And research in Japan showed an interdisciplinary application of intensive rehabilitation therapy by an OT, a SALT and a physiotherapist increased functional gain in elderly stroke patients. [9]
So let’s talk…
The UK’s annual Time to Talk Day aims to break down mental health barriers and myths and encourage everyone to talk about their mental health concerns.
And this year’s theme, ‘The Power of Small’ set Krysalis blogger, Anne Ricketts thinking about the one voice no-one should ignore after brain injury… How the still small inner voice of calm can aid mental health after brain injury.
It is often the voice within our own head, and the conversations we have with ourselves, that have the biggest influence on our perceived potential and subsequent interaction with others.
Jo Throp, occupational therapist, and clinical director at Krysalis.
“The brain is wired to offer a constant narrative or interpretation of the environment or situation it is faced with. It is essential that we are conscious ofthese conversations andreflect on how they may or maynot be influencing our subsequent reactions or mood.”
“Working to develop insight into our responses within the context of daily activity is really important.Recognising that the only control we have over a situation or environment is how we respond to it.”
“Negative feelings such as anxiety or low mood, are associated with negative thought processes. Work with your inner voice to think about ‘doing things (or activities) that will serve you well’. This is a great little phrase used in the context of putting yourself first regardless of what is going on in the world, at school, work or on social media.”
The longest and most important conversation you will have throughout the course of your life is with yourself. Treat yourself with compassion and lead that conversation with your heart rather than your head.
Related articles
Music Therapy for Neurological Rehabilitation
Crafts to support neurological occupational therapy and brain-injury rehabilitation
200 Home activities for brain injury survivors and their families
Twenty apps to boost brain injury rehabilitation
Waltz with us on world stroke day
How to enjoy a daily dose of exercise despite brain injury
References
1. https://www.rcslt.org/policy/communication-access-uk/#:~:text=Up%20to%2014%20million%20people,a%20long%2Dterm%20communication%20need
2. https://www.time-to-change.org.uk/get-involved/time-talk-day
3. Mahoney, D. et al., “A Scoping Review of Self-Awareness Instruments for Acquired Brain Injury,” The Open Journal of Occupational Therapy, Apr 2019.
5. https://www.stroke.org.uk/sites/default/files/Communication%20aids%20&%20computer%20therapy.pdf
6. https://www.rcot.co.uk/news/help-influence-future-research-occupational-therapy
7. https://www.rcslt.org/help-and-support/research-overview/
8. Brady, M. Et al., “Speech and Language Therapy for Aphasia After Stroke: An Updated Systematic Review and Meta-Analyses,” Cochrane Database of Systematic Reviews, Sept 2016.
9. Kamo, T. et al., “Effectiveness of Intensive Rehabilitation Therapy on Functional Outcomes After Stroke: A Propensity Score Analysis Based on Japan Rehabilitation Database,”