Adult Speech and Language Therapy

Our Adult Speech and Language Therapy Service provides assessment and therapy for adults with communication and swallowing difficulties in various settings.

During an inpatient admission to hospital
In outpatient clinics based in the acute and community hospitals within Lincolnshire. Transport may be available for hospital based clinics where patients are unable to use public transport.
In community clinics
Where clinically appropriate we may be able to provide home visits to see patients in their own homes, or to visit patients at nursing and residential care homes.

We provide assessment, therapy and support for adults over 18 years of age with communication and/or swallowing problems. These difficulties may be due to:

traumatic brain injury
neurological conditions
progressive neurological conditions
stroke
dementia (swallowing only)
head and neck cancer
physical disabilities
other medical conditions

We also offer assessment and therapy for adults who have voice difficulties, or adults over 18 years of age who have a stammer.

A Speech and language therapist will be able to assess your communication skills to identify any areas of difficulty with your communication and will advise you on the best way to help with these areas. They may recommend a period of therapy or suggest communication strategies to help you manage the difficulty.

For patients with communication problems, speech and language therapy may help with:

Improving understanding of spoken and written language
Improving production of spoken and written words
Improving the intelligibility of speech
Improving the fluency of speech
Improving voice quality
Improving overall ability to communicate with others

Providing alternative means of communication, for example, through the use of communication aids. This may be supported by other specialist services including the Electronic Assisted Technology Services.

At present, we are unable to offer communication therapy for adults with communication difficulties as a result of dementia.

Swallowing difficulties may occur when there are changes to the movement or co-ordination of muscles of the face, mouth or throat. Speech and language therapists work with people who are experiencing these difficulties. The medical term for a swallowing difficulty is dysphagia. Some people experience swallowing difficulties due to problems within the oesophagus (food pipe) or stomach. These difficulties are managed by doctors rather than speech and language therapists.

Swallowing difficulties may lead to food and drink ‘going down the wrong way’ and entering the airway and/ or the lungs. This is known as ‘aspiration.’ If this happens, people may cough, throat clear, have a wet gurgly voice or their breathing may change. Sometimes they may feel that food and drink sticks in the mouth or throat when swallowing. If food or drink enters the lungs this can lead to repeated chest infections and/or pneumonia. The inability to eat and drink enough may lead to malnutrition and dehydration. Swallowing difficulties may also result in choking. If swallowing difficulties are not appropriately managed, the consequences can be very serious.

For people with swallowing difficulties, speech and language therapy may be aimed at:

Improving swallowing safety by reducing the likelihood of food and drink ‘going down the wrong way.’ Speech and language therapists may recommend a range of strategies which may include modifying the consistency of food/ drinks.
Strengthening the muscles involved in swallowing through direct exercises. Direct exercises are not appropriate for all medical conditions.

Speech and language therapists will give recommendations that are specific to the individual person, taking account of the nature and cause of the swallowing difficulties.

Modifying Food and Fluids

To reduce the risk of aspiration and/ or choking, a Speech and Language Therapist may recommend altering the texture of the foods that are eaten. Different food textures are recommended, dependent on the nature and severity of the difficulty. Sometimes changes to a normal diet may be advised, such as avoiding/ adapting ‘high risk foods.’

Please click here for information regarding high risk foods.

Alternatively, a speech and language therapist may recommend following a specific ‘dysphagia diet’ such as:

Level 4 puree diet
Level 5 Minced and moist diet
Level 6 Soft and bite sized diet
Level 7 Regular diet

These dysphagia diets follow national descriptors. The descriptors were developed by the National Patient Safety Agency Dysphagia Expert Reference Group jointly with Cardiff and Vale University Health Board. The diets are approved by the British Dietetic Association, the Royal College of Speech and Language Therapists, Hospital Caterers Association and the National Nurses Nutrition Group.

Pureed Diet (Level 4)

Minced and Moist Diet (Level 5)

Soft and Bite-sized Diet (Level 6)

To safely swallow normal drinks the throat muscles must be in excellent working order. Swallowing is a very complicated process, which involves a series of muscles working together quickly to ensure your airway closes. If the muscles are weak, liquid may ‘go down the wrong way’ which can lead to chest infections or aspiration pneumonia which can be fatal.

To reduce the risks of drinks entering the lungs, a speech and language therapist may recommend thickening your drinks using a fluid thickener. To thicken fluids, they are mixed with a thickening powder. If required this thickener is prescribed by a GP or a doctor in hospital. The thickener does not contain any medicine or nutrition. It can reduce the risks of fluids going the wrong way as when fluids are thicker, they move more slowly which gives the muscles time to work and therefore makes it easier to swallow safely.

A speech and language therapist will determine what consistency your fluids need to be to allow them to be safely swallowed and will advise you how much thickener is needed. It is essential to follow this guidance including the measuring and mixing instructions. There are different types of thickener.

To describe different types of consistency, different terms are used:

Level 1 Slightly thick consistency
Level 2 Mildly thick consistency
Level 3 Moderately thick consistency
Level 4 Extremely thick consistency

Please note this NHS England Patient Safety Alert relating to use of thickening powders

Please click on the links below for further information and guidance as to how to safely prepare thickened fluids.

Slightly Thick Consistency Drinks (Level 1)

Mildly Thick Consistency Drinks (Level 2)

Moderately Thick Consistency Drinks (Level 3)

Extremely Thick Consistency Drinks (Level 4)

Adults with Communication Difficulties

Adults with communication difficulties (for example, slurred speech , difficulties with understanding spoken/ written language, difficulties with speech production or stammering/ stuttering) can refer themselves directly to our service by contacting us. Alternatively, they may see their GP or health professional and ask for this referral to be made for them.

Adults with Voice Difficulties

All individuals who wish to be seen for a voice assessment must initially be seen by the Ear, Nose and Throat Department. Referral to the Ear, Nose and Throat Department can be arranged by your GP if appropriate. We are unable to offer an appointment for voice assessment without information from the Ear, Nose and Throat Specialist with details of the appearance and function of your voice box. Without this information, we are unable to develop a therapy plan to support your difficulties.

Adults with Swallowing Difficulties

Referrals for swallowing assessments must be made in writing. We accept referrals from GPs, Hospital Consultants, Nurses and other Allied Health Professionals. Care and Nursing homes are required to contact the GP for referral.

You may be contacted before an appointment is offered for assessment to discuss any specific requirements. An appointment time, date and location would then be confirmed by telephone and/or by letter.

Waiting Times for Our Service

Referrals to our service are prioritised based on urgency and risks to the patient.

For information or referrals, please contact us at:

Adult Speech and Language Therapy Services
Bourne Health Clinic
St Gilbert's Road
Bourne
PE10 9XA

Telephone: 01778 426149

Email: LHNT.SLT@nhs.net

The nature of your first appointment will depend on your reason for referral to us. You may have been referred for a swallowing assessment, communication assessment, or for both.

Your initial appointment will be organised via phone and/or letter.
This first appointment may take up to one hour.
Your first appointment may be in a community clinic or hospital outpatient department. Where appropriate, the service will provide home visits for those patients whose condition prevents them travelling to clinics.
You are welcome to have a friend or family member present with you during your assessment if you think that this would help.
During this appointment, the speech and language therapist will ask you some questions about your medical history and the difficulties you are having.
If you have communication difficulties, you may be asked to complete some assessment tasks so the speech and language therapist can see what help you may need.
If you have swallowing difficulties, the therapist may ask you to have something to eat or drink so they can assess your swallowing. You do not need to fast for this assessment.
There will be plenty of time for you to ask questions.

Once you have been seen, the speech and language therapist will discuss what advice or support might be needed to manage your communication or swallowing difficulties. You will then both agree on a management plan. The therapist will also send a written report to the person who referred you to the service explaining the outcome of the assessment.

Where appropriate, you will be offered a period of speech and language therapy to work on your communication or to support you with your swallowing difficulties. Alternatively, if therapy is not appropriate, you may be given advice and discharged from the service, and/ or referred on to another service

Cancelling or changing appointments

If you need to change or cancel an appointment please tell us as soon as possible so that we can offer your appointment to another person. Please note, if you fail to attend your appointment without letting us know, you may be discharged from the service without an assessment.