Outpatient Speech and Language Therapy Service

Dysphasia is a language/communication disorder brought about by changes to the language centre of the brain. These changes may be caused by;

• A stroke
• A head injury
• A brain tumour
• Another neurological illness

Someone with Dysphasia (sometimes called Aphasia if all language abilities are lost) may have difficulty with;

• Speaking (expressive dysphasia)
• Understanding  (receptive dysphasia)
• Reading
• Writing
• Using numbers
• Dealing with money
• Telling the time

The role of the speech and language therapist (SLT) is to work with the client to establish their individual, communication goals. This may involve intensive therapy, online therapy and therapy programmes that can be carried out at home. The SLT will also help to educate and support the individual’s partner/carer/family in order that they feel confident in their ability to support with their communication.

Useful links:

• Stroke
• Aphasia Definitions
• Aphasia

Dysarthria is a speech disorder which occurs as a result of damage to the brain through:

• Stroke
• Traumatic brain injury
• Brain tumour

Or as a result of changes to the brain through:

• Parkinson’s Disease
• Multiple Sclerosis
• Motor Neurone Disease
• Huntington’s Disease

Dysarthric speech is often slurred and difficult to understand, although the severity can vary from mild to severe. Speech and Language Therapists can help teach strategies to improve speech clarity and improve some symptoms associated with dysarthria.

Useful links:

• Parkinson’s UK
• MS Society
• Stroke
• Huntington’s Disease
• Dysarthria

Dysphagia is the medical term for swallowing difficulties. Swallowing difficulties can arise as a result of a number of different conditions and can present themselves in a number of different ways.

Some conditions which can cause dysphagia include:

• Stroke
• Parkinson’s Disease
• Multiple Sclerosis
• Huntington’s Disease
• Dementia
• Brain Injury
• Acid Reflux
• Bell’s Palsy

Some of the difficulties people with dysphagia may experience include:

• Difficulty chewing food
• Losing food or fluid from the front of the mouth
• Coughing on food or fluid
• Food sticking in the throat
• Choking sensation
• Regurgitation (bringing food/fluid back up)
• Weight loss
• Recurrent chest infections
• Shortness of breath after swallowing

Speech and Language Therapists (SLTs) assess and manage swallowing difficulties within the outpatient setting. During your appointment, the SLT will take a detailed history of your swallowing difficulties and will carry out a non-invasive swallow assessment.

Advice and recommendations will be made following your assessment on how to manage your swallowing difficulties.

Exercises and strategies may be provided in order to improve or compensate for swallowing difficulties. Occasionally, people with dysphagia will need to make modifications to their diet and fluid in order to make it easier for them to eat and drink. Your SLT will discuss the options with you in detail so that you can make an informed decision about how you will manage your eating and drinking.

Some people require further investigation following an initial swallow assessment and will be referred for a Videofluoroscopy (video x-ray of the swallow). If you require this following your initial appointment, the SLT will discuss the procedure in more detail with you.

If you feel you have a swallowing problem and require input from Speech and Language Therapy, you can request a referral from your GP, Consultant or specialist doctor/nurse. Alternatively, you can self-refer to our service by telephoning 02920 743012 or emailing cav.sltoutpatients@wales.nhs.uk.

Useful links:

• What to expect in your swallow assessment (Microsoft Word)
• International Dysphagia Diet Standardisation Initiative

Neurological problems occur as a result of damage to the nervous system, such as injury to the brain, spinal cord or nerves. Neurological problems can be acquired as a result of sudden injury to the nervous system e.g. a stroke or head injury, or can be a result of a progressive disorder where the problems will worsen over time.

Neurological problems can result in a variety difficulties which will be dependent on the area of the nervous system that has been affected. Neurological problems can cause changes with muscle function, speech, language (both speaking and understanding), swallowing and social communication.

Speech and language therapy is highly beneficial for adults with neurological problems.

This can include:

• Parkinson’s Disease (PD)
• Multiple Sclerosis (MS)
• Stroke
• Cerebral Palsy
• Traumatic Brain Injury (TBI)
• Huntington’s Disease (HD)

A speech and language therapist will provide individualised treatment plans tailored to the specific needs and abilities of each client. The type of treatment given will depend on many factors including the underlying cause of the neurological problem, the severity of the problem, the area of the nervous system which has been affected as well as the client’s own goals.

Useful links:

• Parkinson’s UK
• MS Society
• Stroke Association
• Cerebral Palsy
• Huntington’s Disease

Stammering (or Stuttering) is thought to be a neurological condition that makes it physically difficult to speak. Someone who stammers may repeat, prolong or get stuck on some sounds or words. There may also be signs of visible tension as the person struggles to get the word out.

For up to 3% of adults, stammering will be a lifelong condition.  There is no link between stammering and intellectual capacity, and it has nothing to do with flaws in someone’s character. It affects mainly men and every ethnicity. The way someone stammers may differ from someone else who stammers and to a different degree; for some there’ll be periods of their life when they stammer less and others when they will struggle to speak. Many find that as they get older the condition improves.

A speech and language therapist can support someone to live well with their stammer, providing individualised therapy and management strategies, tailored to the specific needs of each client. The type of treatment will depend on the client’s goals for therapy.

Useful links:

• Stamma

The Outpatient Speech and Language Therapy team offer a service for transgender clients which focuses on vocal feminisation or masculinisation.

Speech and Language Therapists (SLTs) can support you in finding your authentic voice in a healthy and safe way and offer assessment, education, advice and strategies to support you through your vocal transition.

Typically, referrals to SLT come through the Gender Identity Clinic based in St David’s Hospital, however, you are able to self-refer or request a referral to our service from your GP if you are not currently under the care of the GIC. 

Useful links:

• Gires
• Depend
• Mermaids UK

Dysphonia is the medical term for abnormal changes to the voice. People who are experiencing dysphonia may have a voice that sounds hoarse, strained, weak, breathy, raspy, or a combination of these. People may also experience changes to the way their throat/voice box feels, this may feel like tightness, muscle tension, or soreness.

Dysphonia may occur as a result of having a job which requires you to use your voice regularly throughout the day, for example, a teacher, a call centre worker, or a singer. Voice changes may also occur due to stress or emotional factors. People with certain medical conditions may also experience dysphonia, these may include:

• Acid Reflux
• Laryngitis
• Chronic Obstructive Pulmonary Disease (COPD)
• Head and Neck Cancer
• Communication and Swallowing changes after Covid-19

If you have had voice changes that have persisted for longer than 2 weeks or you have pain associated with using your voice, you should visit your GP to see if a referral to the Ear, Nose and Throat (ENT) department is needed.

The ENT doctor will discuss your voice changes with you, carry out an assessment of your voice box, diagnose the reason for the changes, and refer you to the Speech and Language Therapy (SLT) team if you would like further support to improve your voice. You cannot self-refer to the Speech and Language Therapy Department for dysphonia as SLTs cannot work with people with dysphonia until they have been seen by ENT.

If you are referred to the SLT department, you will be offered an initial individual or group appointment dependent on your needs. “Virtual therapy” is also offered via video consultations. During your appointment the SLT will take a detailed history of your voice changes and will carry out an assessment of your voice.

The SLT will provide you with advice and information, and if needed they will work with you to establish a programme of exercises that you can complete at home to improve your voice.

General voice care advice:

• Drink plenty of water (6-8 glasses per day)
• Avoid excessive amounts of caffeine, try switching to decaf or herbal teas
• Avoid eating large meals before bed as this can cause acid reflux when you lie down
• Try to avoid clearing your throat unnecessarily
• Avoid shouting or raising your voice over background noise
• Notice if any emotional factors may be having an impact on your voice
• Seek medical advice from your GP if you are concerned about voice changes

Useful links:

• The British Voice Association