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Stroke Service

A small team of stroke specialist SLTs cover the Acute Stroke Unit at Worcestershire Royal Hospital.  We run a 6-day week service (not available on Saturdays). 

We are involved in the assessment and therapy for both swallowing and communication following a stroke.  Patients may present with one or all of the following: aphasia (language impairment), dysarthria (speech impairment), apraxia of speech (speech impairment), dysphagia (swallowing impairment).

All patients admitted to the Stroke Unit are triaged by SLT Services within 72 hours of admission to ascertain if speech and language intervention is required.   Not all patients admitted to the Stroke Unit will have SLT needs because their swallow and communication have not been affected by their stroke or their symptoms have resolved quickly.

Patients who have speech and language and/or swallowing therapy needs are assessed, regularly monitored and will receive direct therapeutic input from SLT during their inpatient stay. 

The SLT team work as part of a larger multi-disciplinary team on the Unit.   In the early days following a stroke, patients may have a variety of medical and other needs i.e. mobility, cognition.  These may require the involvement of other therapy teams such as physiotherapy and occupational therapy.  We take account of individual patient therapeutic priorities, post stroke fatigue and medical needs of the day and work closely with our other speciality colleagues on the unit. 

Patients sometimes require a little time to become medically stable and in the ‘right place’ to commence swallow or communication therapy.  We aim to tailor our approach to the individual to support and optimise their post stroke recovery.  Sometimes, in the early stages following a stroke, it may be necessary for us to recommend nasogastric tube (NGT) feeding to support nutrition and hydration to allow some time for further recovery. 

We are readily available on the Unit to offer advice, support and education to patients and their families.

Head and neck cancer service

We run a specialist head and neck cancer service based at Worcestershire Royal and are part of the wider head and neck cancer multidisciplinary (MDT).  We attend weekly MDT meetings and run joint Allied Health Professional Clinics (AHP) with the specialist dietitians and Clinical Nurse Specialist.

Our aim is to support you during your cancer journey from time of diagnosis, during treatment and living well after completing your treatment. We appreciate everyone’s experience and treatment is different, and we hope to help you adapt to any changes in your function, or side effects of treatment and rehabilitate you to a new normal by providing our specialist assessment and advice.

We work closely with our Ear, Nose and Throat and Maxillo-facial Consultants and can see you jointly at your reviews with them as part of your 5-year cancer follow up, should you have any concerns about your swallow or communication.

Before treatment:

People present differently at the time of their cancer diagnosis. Some people may only notice a small neck lump, whilst others will notice difficulties with swallowing, a change in their voice or weight loss. Our aim before your treatment is to stabilise your situation so that you are at your optimum before starting or considering any treatment options. Often treatment may range from surgery to radiotherapy +/- chemotherapy.  Radiotherapy is offered at Worcester Royal Hospital and Hereford Hospital.

You may be referred on to a cancer centre should you need major surgical reconstruction and we handover to the team looking after you there.

The aim of seeing you before you start any treatment is to understand and know you better, optimise your current function and/ or provide recommendations that may offer you the most comfort or safety. We also run a two weekly pre-habilitation group where you can meet other people about to start radiotherapy treatment. If appropriate you will be provided with exercises to help you keep swallowing during your treatment.

During treatment:

We have close links with our oncology team including Specialist Radiographers and Consultants. During radiotherapy we will see you as part of the team for your weekly Thursday review in the Oncology Centre, to help you through your treatment and problem solve any difficulties you may be experiencing. 

After treatment:

Sometimes it can be difficult to re-start eating and drinking. Initially we will observe you eating and drinking as and when we establish it is safe to do so. If we need further information we may conduct a video-fluoroscopy (x-ray of your swallow) or FEES (fibreoptic endoscopic examination of the swallow), where a camera is gently placed to look at your throat and your swallow is assessed on food and drink.

We tailor your follow up depending on your needs and can see you as regularly or infrequently as you require. We can offer swallow rehabilitation programmes and voice exercises as required.

Sometimes, although you are able to swallow safely, people find other side effects may bother them more and so we can sign post you to the appropriate people.

Laryngectomy and Surgical voice restoration:

We are trained and able to manage people with laryngectomy and are able to offer advice surrounding ways to communicate and problem solve any difficulties with swallowing. We offer a flexible speaking valve change and trouble-shooting service and can be contacted on the main SLT office number should this be required (01905 760475).  Worcestershire has an active laryngectomy support group. Should you require any information please do not hesitate to contact your speech and language therapist.

Dysphagia Specialist Outpatient Service

We run a weekly morning outpatient clinic at Worcestershire Royal Hospital for people with swallowing problems who have been referred by the Ear, Nose and Throat team.

What you can expect from this service:

• A consultation to gather information about the swallow problems you are experiencing.
• Assessment of your swallowing; we may observe you eating and drinking. If we need a better understanding of the nature of your swallowing difficulty we may invite you for a videofluoroscopy (a video x-ray of your swallow) or FEES (fibreoptic endoscopic examination of the swallow), where a camera is gently placed to look into your throat.
• We will discuss with you what we can offer in terms of advice, education and therapy. Examples of these may be;
  • suggesting food and drink consistencies which are safer/easier when swallowing
  • strategies which may help to improve swallow comfort or swallow safety
  • exploring alternative options if you have a significant swallow problem which may negatively affect your health e.g. non-oral tube feeding, eating and drinking accepting risk
  • a personalised exercise programme targeting the muscles used for swallowing
  • signposting to other services/specialisms e.g. gastroenterology, psychological services, dietitians
• We will agree a treatment plan with you, if needed, based on your individual needs. This includes when and how you will be discharged from the service.

Voice therapy

Specialist clinics for people who have been referred by the Ear, Nose and Throat (ENT) team with voice problems are held at all three of our hospital sites; first floor of Aconbury West at Worcestershire Royal Hospital, Outpatient Department 5 at the Alexandra Hospital in Redditch and in Audiology at Kidderminster Hospital.

Attending for voice therapy

You will have been referred to us by your Ear Nose and Throat doctor. This person and your GP will be kept informed of your progress by letters written following your initial and final appointment.

You will be seen by a speech and language therapist who will be responsible for your assessment and treatment. Your appointment may be via telephone or video link in the first instance but thereafter it is usually easier to work in a face to face session.

What is voice therapy?

Voice therapy involves the assessment and treatment of problems with the voice.

It may be that an indirect approach will be helpful in order to manage your voice problems. This could include educating you in ways to care for your voice, or it may be that your voice will be improved by a programme of exercises devised specifically for you.

The voice therapist will talk to you about the best way to improve your voice when you meet with them on the first visit.

Before your appointment

If you are unable to attend for any reason, please let us know as soon as possible by contacting the department on 01905 760475. If you fail to attend an appointment without informing us you will be discharged from our service. If, for any reason, you would rather not take up the offer of voice therapy, then please let us know so we can inform your GP and ENT doctor of your decision.

If you do not speak English please tell us before your first visit so that we can arrange an interpreter for your first appointment.

Please bring your appointment letter with you on each visit. If you wear glasses please also bring these with you along with any exercise sheets you have been given by the department.

Your appointment

Please try and attend your appointment on time. We try, as far as possible, to see people on time.

Your appointment will last for half an hour to an hour. On your first visit you will be offered a course of treatment and further appointments if appropriate. If there is anything you do not understand about your treatment, please just ask.

After your appointment

If you are given exercises to do at home, you will be expected to do these on a regular basis. If you have any questions or concerns before your next appointment you can contact the department on the number given.

After a course of treatment, you will be discharged from the Speech and Language Therapy department but you can contact us if you have any further problems.

Below are some of the words you may hear your Speech and Language Therapist and other professionals use to describe your speech and swallowing.

Cognition

Cognition affects your ability to do any task, it includes the processes of thinking, knowing, remembering, judging and problem-solving.

Dysarthria

This is a term used to describe a weakness in the muscles used for speech, this can affect the clarity of speech and it may have a slurred quality.

Dysfluency

This is when the fluent flow and timing of speech is interrupted by stoppages. This may also be called stammering or stuttering.

Dysphagia

This term is used to describe difficulties with swallowing; these can happen as a result of a stroke, head injury, oral surgery or progressive diseases such as Parkinson’s Disease, etc.

Dysphasia or Aphasia

General term used to describe language problems which can result from a stroke or head injury. It can affect one or all of the areas of communication i.e. understanding, speech, reading and writing.

Dyspraxia or Apraxia

This is a condition which affects the ability to sequence and coordinate the muscles used for speech. There is often no weakness in the muscles themselves but it is more difficult to move them when and how you want to.

Language

The knowledge and use of words to convey meaning, this can be spoken, written, signed or represented by symbols.

Multidisciplinary team

A group or team of professionals that work, assess, and/or deliver treatment to clients e.g. Speech and language therapist, Physiotherapist, Occupational therapist or consultant.

Speech

The ability to produce and articulate sounds in order to form words.

Voice disorder

A voice disorder is an abnormality of or change in a person’s voice. This can be a change in the pitch, volume and quality of the voice.

Health professionals

How to make a referral from within the Trust for a current inpatient:
(For the Alexandra and Worcestershire Royal Hospitals)

Please refer via ICE. When making a referral please include:

Patient's name
Hospital and/or NHS number
Date of birth
Current diagnosis
Relevant PMH
Reason for referral e.g. swallow and/or communication
Current nutritional status e.g. NBM, NG feeding

If you are a GP and would like to make a referral for voice therapy:

Patients referred for voice therapy will first need to be referred to an ENT consultant before being seen by speech and language therapy.

Our service does not cover people under the age of 18.

Community Referrals:

If community Speech and Language Therapy is required, then referrers should contact the Worcestershire Health and Care NHS Trust Community Adult service based at Droitwich Medical Centre.

The contact details are as follows:

Service Manager (Jackie Murphy) and Admin Support (Tracey Morris): 01905 681049 / 07519 069964
Email referrals to: Whcnhs.adultsltreferrals@nhs.net

Address: Worcestershire Adult Speech and Language Therapy Service,
Service office: c/o Droitwich Medical Centre,
Ombersley Street East,
Droitwich,
WR9 8RD

We provide speech and language therapy services at the Alexandra Hospital, Redditch and Worcestershire Royal Hospital.

Speech and Language Therapy
Worcestershire Acute Hospitals NHS Trust
Aconbury West
Worcestershire Royal Hospital
Charles Hastings Way
Worcester
WR5 1DD

Email: wah-tr.SpeechLanguageTherapy@nhs.net

Phone number: 01905 760475