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 stemThis is the most primitive part of the brain, connecting the rest of the brain to the body, via the spinal cord. In addition to feeding signals to and from such “higher centres”, the brain stem contains a number of important control centres, regulating vital functions such as breathing and blood pressure.. 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).
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 cerebellumThis word means the “little brain” and refers to a large part of the brain that sits in lowermost part of the skull, at the back of the head, immediately above the top of the spine. This part of the skull is known as the posterior fossa., is immediately next to the brain stemThis is the most primitive part of the brain, connecting the rest of the brain to the body, via the spinal cord. In addition to feeding signals to and from such “higher centres”, the brain stem contains a number of important control centres, regulating vital functions such as breathing and blood pressure.. The Chiari malformationAn anatomical abnormality affecting the lowermost part of brain, where it joins the spinal cord, at the top of the neck. Various sub-types are described – see under their individual names. The term hindbrain hernia is sometimes used to incorporate all forms. ( or hindbrain herniaAn alternative term for a Chiari malformation. It is better than the eponymous term because it is in many ways more descriptive of the anatomical abnormality.) 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 syringomyeliaA cavity, within the spinal cord, which is filled with cerebrospinal fluid. Syringomyelia cavities come in various “shapes and sizes”, from short, spindle-shaped cavities through to long, tense cavities extending throughout the greater part of the spinal cord. Read more referred to as syringobulbiaOn rare occasions a syringomyelia cavity may enlarge in an upward direction, from the cervical spinal cord, into the brain stem. The word bulb refers to the brain stem and syringobulbia refers to a cerebrospinal fluid containing cavity within the brain stem., present first to an ENT specialist, rather than to a neurologist or a neurosurgeon. This will be when a dominant symptomA symptom is anything of which a patient complains with respect to his or her own body. It may also be obvious to an observer, for example a rash, but it may be entirely subjective, such as a pain somewhere or an emotional feeling. 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 syringomyeliaA cavity, within the spinal cord, which is filled with cerebrospinal fluid. Syringomyelia cavities come in various “shapes and sizes”, from short, spindle-shaped cavities through to long, tense cavities extending throughout the greater part of the spinal cord. Read more. 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 syringomyeliaA cavity, within the spinal cord, which is filled with cerebrospinal fluid. Syringomyelia cavities come in various “shapes and sizes”, from short, spindle-shaped cavities through to long, tense cavities extending throughout the greater part of the spinal cord. Read more 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 stemThis is the most primitive part of the brain, connecting the rest of the brain to the body, via the spinal cord. In addition to feeding signals to and from such “higher centres”, the brain stem contains a number of important control centres, regulating vital functions such as breathing and blood pressure. by the Chiari or syrinxA character from Greek mythology, widely depicted in classical art. Pursued by the god Pan (half man and half goat), who wished to have his wicked way with her, Syrinx fled but became trapped by the side of a river. She pleaded to the gods for deliverance and was transformed into a bed of water reeds. She thereby gave her name to tubular structures, the most obvious of which is “syringe”. The word syrinx is frequently used as an alternative to syringomyelia. Experts also disagree over whether the pleural of the word should be “syrinxes” or “syringes”. include:
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 malformationAn anatomical abnormality affecting the lowermost part of brain, where it joins the spinal cord, at the top of the neck. Various sub-types are described – see under their individual names. The term hindbrain hernia is sometimes used to incorporate all forms./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:
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.