Louise Spence, Dysphagia Specialist Speech and Language Therapist

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My name is Louise Spence and I am a Dysphagia Specialist Speech and Language Therapist.

I arrive at my desk and check the number of new referrals that have arrived overnight. A quick check for any patients that we already know and then pass the referrals on to our fantastic SLT assistant Danielle who will log the referrals and then search Lorenzo and take a good history so that we can prioritise the patients and make a list of who needs to be seen that day. This list will include any reviews already on our caseload and the prioritised new referrals too.

Part of my role is to lead our inpatient Dysphagia SLT team, supporting more junior members of staff, and distributing the caseload for the day.

We assess patients swallow initially at the bedside and use observation, assessment of the oral cavity, tongue, lips and their movement and coordination. Voice and cough strength are important as is the patient’s breathing and breath control. The patient’s own description of their difficulties can be invaluable but many of our patients will also have communication or cognitive difficulties, which we can assess and advise on. Patients who need more ongoing input re communication will usually be seen by one of my colleagues.

Our main aim is to establish whether the patient has a safe swallow, and if not, what changes can we make to reduce the risk of aspiration and the potential dangers of an aspiration related pneumonia. If this is not possible, we will need a discussion with the MDT, to make decisions about whether non-oral feeding is appropriate, and whether the patient has capacity to contribute to this decision.

As well as working on the general wards I am also the main SLT covering ICU. Many tracheotomised patients will experience swallowing difficulties and will often need SLT involvement as part of the weaning process. They may also need support with communication.

I also participate in our weekly Videofluoroscopy Clinic, where we work closely with our Radiology colleagues to provide an objective assessment for patients where our bedside assessment has been inconclusive.

All of the above carries quite a lot of potential for high emotional challenge as feeding and nurturing loved ones and the patient’s in our care is a very strong human instinct. My links with the wider MDT are hugely important, as is the support we offer each other within our SLT team. All in a day’s work!!

I absolutely love my job and feel privileged to do what I do at Warrington Hospital.