Speech and Language Therapy

The third category of “therapies” that patients may come across in a hospital setting is that of speech and language therapy. Often referred to, by other hospital staff, as “SALT”, this group of allied healthcare professionals do, as their title suggests, deal with people who have problems with verbal communications. In addition, however, they deal with a wider range of disturbances of normal neurological functions including, in particular, difficulties with eating, drinking and swallowing This broader role reflects the fact that these various bodily functions are controlled by centres which are close together, in part of the brain referred to as the brain stem. A moment’s reflection will make it obvious that swallowing and speaking both involve quite sophisticated co-ordination of lip, tongue and throat muscles, as well as control of the voice box (larynx).

Additional information

Brain anatomy relevant to Chiari malformations is covered elsewhere on this website. The point to note here is that the anatomical abnormality, involving as it does the lower part (tonsils) of the cerebellum, is immediately next to the brain stem. The Chiari malformation ( or hindbrain hernia) can therefore affect the nerve control centres that regulate tongue, palate and throat muscles.

Speech and language therapists work directly with patients, carers and other professionals. including nurses, physiotherapists, occupational therapists and doctors. A group of medical practitioners with whom they interact closely are ear, nose and throat (ENT) surgeons – or, increasingly a sub-specialist group of surgeons who specialise on “throat” conditions.

Hindbrain hernias (Chiari malformations) and, sometimes, a particular type of syringomyelia referred to as syringobulbia, present first to an ENT specialist, rather than to a neurologist or a neurosurgeon. This will be when a dominant symptom is that of articulation or swallowing difficulties, as opposed to the more typical cough-related headache. In other circumstances, disturbances in these neurological functions may come about as complications of surgical intervention for Chiari or syringomyelia. In either case, the ENT surgeon, or the neurosurgeon, will very likely seek the help of a speech and language therapist.
Therapists seeing Chiari or syringomyelia patients will usually note the common, hallmark features of headaches, neck pain, hearing or balance problems, muscle weakness or numbness affecting various parts of the body. These symptoms may then exacerbate, or be aggravated by symptoms such as swallowing difficulty or problems in articulating words. Features that point to involvement of the brain stem by the Chiari or syrinx include:

  • Frequently coughing when eating and drinking
  • Struggling to chew food due to muscle weakness
  • Speech changes including altered breathing patterns, clarity and an inability to produce certain sounds
  • Overall facial weakness/numbness or paralysis.

As always with medical symptoms, there can be a variety of causes of each of the above, in combination or in isolation. Anybody experiencing any of the above should therefore talk to his or her GP. A referral to the local speech and language therapy department may be a first line of further assessment. When these sorts of symptoms are noted in somebody who is already a hospital inpatient, the supervising medical or nursing team will usually make the referral. SALT staff can assess patients both before and after surgical intervention for Chiari malformation/syringomyelia. Patients can also be referred for community SALT support on discharge from hospital, if required.

Once involved in a person’s care, the SALT service can help by:

  • Assessing communication and swallowing disorders
  • Identifying the likely cause
  • Assessing the safety of oral intake and ensure that the individual is able to eat and drink safely
  • Recommend changes to diet/fluid intake
  • Explain to patients the anatomical and physiological changes that are affecting their swallowing or speech functions
  • Teach someone how to compensate safely for his or her speech or swallowing impairment
  • Make recommendations about home or workplace adaptations

Most patients are aware of their speech or language problems and are encouraged to let the SALT specialist know about any improvements or deteriorations in his or her symptoms. This is so that the therapist can monitor progress and make adaptations to the ways in which you eat, drink and communicate as required.