Adult speech and language therapy - community

Aphasia is a language problem. It can affect how you understand, speak, read or write.

Causes

It often occurs after a stroke or brain injury. Other causes include conditions like dementia or brain tumours.

The type and severity of aphasia depends on location and how much of the brain is affected.

Symptoms can include

• Trouble speaking or saying thoughts clearly
• Trouble understanding what others say
• Trouble reading or writing
• Using the wrong words (for example, calling a book a ‘chair’)
• Difficulty retrieving names of people, objects, or places

Diagnosing aphasia

We will ask questions about your medical history and communication changes. We will also ask you to do language tasks to find out the type and level of your aphasia.

Treatment

• Language exercises such as naming objects or describing pictures
• Reading and writing practice
• Using gestures, pictures, or communication boards as support
• Communication aids to support language
• Training for family and carers to help with communication

Living with aphasia

Aphasia can make communication slower and more frustrating. Practice and therapy can help.

• Use gestures, writing, or communication aids when needed
• Help others learn how to support your communication
• Work with a therapist to set goals and track progress
• Join a support group to meet others with aphasia and share tips

Supporting someone with aphasia

• Be patient, as communication may take longer
• Offer choices if the person struggles to find a word
• Speak slowly and clearly
• Check often to make sure they have understood
• Encourage any form of communication—gestures, drawing, writing, or communication boards

Apraxia of speech is a motor speech disorder. This means the brain has trouble planning and coordinating the movements needed for speech.

It is not caused by weakness or paralysis of the muscles. It is a breakdown in the brain's ability to send the correct signals to the speech muscles.

Causes

It is caused by damage to the parts of the brain that control speech. The most common cause is stroke. Other causes include:

• serious brain injury
• brain tumour
• disease or infection of the brain and nervous system

Symptoms

• Different errors when saying the same word at different times
• Trouble saying long words or phrases
• Groping movements of the mouth due to difficulty positioning the lips, tongue, and jaw to make sounds
• Trouble coordinating breathing with speech
• Trouble starting to speak
• Unclear speech

Diagnosing apraxia of speech

We will ask questions about your medical history and communication changes. We will also ask you to do speech tasks to find out the level of apraxia:

• sound production
• word repetition
• planning skills

Treatment

• Speech exercises for specific sounds or words
• Use of visual (by seeing) or tactile (by touching) prompts to help you understand how to move your mouth for clearer speech
• Using communication boards as support

Living with apraxia of speech

Apraxia of speech can make communication slower and more frustrating. Practice and therapy can help.

• Use gestures, writing, or communication aids when needed
• Help others learn how to support your communication
• Work with a therapist to set goals and track progress
• Join a support group to meet others with apraxia and share tips

Supporting someone with apraxia

• Be patient, as communication may take longer
• Encourage any form of communication—gestures, drawing, writing, or communication boards

Cognitive communication impairment (CCI) happens when the thinking skills that support communication are affected. These skills include:

• attention
• memory
• problem‑solving
• reasoning
• planning

When these skills are weaker, you may find it hard to organise your thoughts or express them clearly. This can affect how you understand and use spoken or written language.

Causes

• Traumatic brain injury, such as a concussion or a strong blow to the head
• Stroke, which can damage areas of the brain involved in language, memory, and problem‑solving
• Conditions like Alzheimer’s disease, primary progressive aphasia, or Parkinson’s disease
• Ageing, which can cause slower thinking
• Infections or illnesses that affect the brain, like encephalitis

Symptoms

• Trouble organising thoughts
• Trouble finding the right words in conversation
• Trouble staying focused
• Forgetting conversations or losing track of discussions
• Trouble understanding complex spoken or written language
• Trouble with abstract ideas
• Trouble understanding social cues, such as humour
• Trouble recognising the emotions of others

Diagnosing CCI

We will ask questions about your medical history and communication changes. We will also ask you to do tasks to check:

• memory
• attention
• problem‑solving
• language skills

Treatment

• Exercises to strengthen attention, memory, organisation, planning
• Training to help with understanding social cues and keeping conversations going
• Strategies such as using planners or reminders
• Education for family members on how to support communication
• Talking about past experiences or looking at old photos to help with memory and conversation
• Using music or art to express emotions when words are difficult

Living with CCI

• Patience is important because communication may be slower or more tiring
• Familiar routines can reduce confusion
• Use gestures, writing, art, music, or communication aids to support speech
• Help family and friends learn how to support communication
• Set realistic goals and track progress
• Join support groups for emotional support and practical advice

Supporting someone with CCI

• Speak clearly and slowly, using short, simple sentences
• Provide structure and routine
• Use visual cues like pictures, written instructions, or schedules
• Allow extra time for the person to think and respond
• Support them in using strategies and tools that help communication

Dysarthria is a speech disorder. It is caused by weak or uncoordinated muscles that control speech.

Causes

Dysarthria happens when there is damage to the nervous system that affects the brain’s ability to control the muscles needed for speaking. Causes include:

• stroke
• Parkinson’s 
• brain tumour
• Motor Neurone Diseases (MND)

Symptoms

• Slurred speech
• Mumbled or unclear speech
• Slow or rapid speech
• Weak or strained voice
• Monotone pitch (voice all on one level)

Diagnosing dysarthria

We will ask questions about your medical history and communication changes. We will ask you to do speech tasks to check the type of dysarthria you have:

• speech clarity
• strength, speed, and coordination of the muscles needed for speaking

Treatment

• Speech exercises such as articulation drills
• Posture and breathing techniques can help speech clarity (how clear it is) and volume (how loud it is). They can also help with tiredness while speaking.
• Using gestures, pictures, or communication boards as support
• Communication aids to support language
• Strategies such as slowing down speech, using pauses, and emphasising words can help others understand more clearly

Living with dysarthria

Dysarthria can make communication slower and more frustrating. Practice and therapy can help.

• Use gestures, writing, or communication aids when needed
• Help others learn how to support your communication
• Work with a therapist to set goals and track progress
• Join a support group to meet others with aphasia and share tips

Supporting someone with dysarthria

• Give them time to speak and don’t interrupt
• If you don’t understand, ask them to repeat themselves or try to communicate in a different way (for example, writing it down)
• Remind them to slow down and focus on clear speech
• Understand they may be frustrated or tired due to difficulty speaking

People who stammer may find it difficult to start or sustain speech. It may involve speech sounds or words being repeated, extended, changed, avoided or blocked. 

It can affect people of all ages. It can vary in how severe it is.

Causes

The exact cause of stammering is not known. Many experts think it happens because of a mix of genetics, brain development or changes over time, and communication environments.

Symptoms

• Repeating sounds or words, for example, ‘I-I-I want to go’
• Stretching sounds, for example, ‘ssssun’ instead of ‘sun’
• Blocks where no sound comes out, even though you are trying to speak
• Using fillers like ‘um’ or ‘uh’ more often to try to continue speaking
• Tension or struggle on your face, for example, repeated blinking or lip-tightening when speaking
• Avoiding certain words or situations

Diagnosing stammering

We will ask questions about your medical history and communication changes. We will ask you to do speech tasks and discuss your feelings relating to speech. These will look at:

• fluency
• speech patterns
• frequency and types of speech disruptions

Treatment

• Techniques to improve fluency e.g. slowed speech, reducing tension and improving the coordination between breathing and speech
• Gradual exposure to more difficult speaking situations
• Scripts to help you feel more confident in situations where you expect to speak, like a work meeting or social event
• Supported conversations to help you manage your feelings relating to your speech
• Invitation to a support group for people who stammer

Living with a stammer

• Focus on communication rather than fluency
• Use cues like gestures and body language to help get your message across
• Accept your speech pattern as part of who you are to reduce anxiety and increase self-confidence
• Explore ways to feel less stress of pressure when speaking
• Regular practice in a comfortable setting can help you become more accepting of moments of stammering

Supporting someone with a stammer

• Avoid interrupting
• Minimise distractions
• Encourage relaxed communication
• Encourage participation

Dysphagia

Dysphagia refers to difficulty swallowing. Speech and language therapists specialise in oral (mouth) and pharyngeal (throat) dysphagia.

Dysphagia may make eating and drinking:

• challenging
• uncomfortable
• unsafe

In severe cases, it can lead to:

• malnutrition
• dehydration
• choking
• aspiration pneumonia (when food or liquid enters the airway or lungs)

Causes of dysphagia

• Conditions which affect the brain or nervous system, like stroke
• Structural problems of the mouth or throat, for example, throat cancer
• Muscle tension
• Sensory changes leading to hypersensitivity in the throat
• Ageing can weaken the muscles involved in swallowing
• Medications that affect the swallow such as sedatives or muscle relaxants

Symptoms

• Food or drink falling out of the mouth
• Difficulty chewing
• Food left in the mouth after swallowing
• Choking on food
• Frequent coughing when eating or drinking
• Food sticking in the throat
• Drooling or difficulty managing saliva
• Unexplained weight loss due to difficulty eating or drinking
• Voice changes after swallowing, like a wet-sounding voice
• Changes in eating habits, such as avoiding certain food textures
• Repeated chest infections with no other clear cause

Diagnosing dysphagia

We will ask questions about your medical history. We will watch you eating and drinking.

If needed, we may refer you for a:

• video-fluoroscopy (x-ray of swallowing)
• endoscopy (a flexible tube with a camera used to look at the throat during eating and drinking)

Treatment

• Exercises for the muscles used in swallowing
• Training to improve your cough reflex
• Strategies such as changing your posture, pacing or using specific swallowing techniques
• Improving mouth care to lower the risk of chest infection
• Changing food textures or thickening drinks to make swallowing easier or safer
• Medications to treat underlying conditions, such as acid reflux, muscle spasms, or neurological disorders
• Surgery to treat certain structural problems, for example, pharyngeal pouch
• We may consider feeding tubes when swallowing is impossible or unsafe

Eating and drinking with acknowledged risk

Sometimes people decide to continue having food and drink they like despite the risks.

In these cases, we will work with you and others involved in your care to reach the best decision for you.

Your GP or another health professional can refer you.

Or you can refer yourself using our online portal.

Please check the 'What can't we help with?' section before making a referral. You must be registered with a Northumberland or North Tyneside GP.

Our service is not right for you if:

• you have issues chewing because of problems with your teeth, but no other swallowing problems
• you struggle to swallow tablets but not other issues
• you are losing weight without meaning to, but do not have swallowing problems
• you have vomiting or stomach issues on their own
• we have previously treated you and there is no change in your condition
• you have a communication and / or swallowing problem due to a lifelong learning disability
• you have dyslexia, autism, selective mutism or communication issues due to d/Deafness
• you have a voice disorder and haven't had an ENT (ear, nose and throat) appointment in the past 6 months
• you have a cough or breathlessness and haven't been seen by a Northumbria respiratory consultant in the past 6 months
• you have a globus sensation (feeling of something in your throat) without seeing an ENT consultant first

Assessment

We will contact you for a first appointment to discuss:

• your needs
• the impact on you
• your goals for therapy

We may do tests to determine how best to support you. We may suggest referral for further tests if we need more information. We will involve you in all decisions about your care.

Report

We will write a report of findings and plan. We will send this to you, your GP, and anyone else involved in your care.  

Therapy

We agree on a therapy plan together. This depends on your goals and the level of support you need.

This could include:

• individual therapy at home
• individual therapy in an outpatient clinic
• telephone or video appointments
• Invitation to a group to practice skills within a supportive setting

Review

After therapy, we will decide together the next steps for you. This may be more therapy, a review, or discharge.

Feedback

We will ask you for feedback to help us continue to improve the service.

If your referral is for communication, we may ask you to: 

• Describe the problem e.g. changes to speech sounds, word finding difficulties 
• Complete some tasks to assess your communication, e.g follow instructions, name pictures, write a shopping list, read a newspaper article 
• Describe the impact your communication problem has on your daily life, e.g. family or employment 
• Tell us anything you already do to help 
• Talk about what you would like to achieve with our support 

If your referral is for swallowing, we may ask you to: 

• Describe the problem, e.g. when did it start, duration, any pattern 
• Tell us what you eat and drink on a typical day 
• Observe you eating/drinking something 
• Describe the impact of your swallow, e.g. avoidance of eating out 
• Tell us anything you already do to help 
• Talk about what you would like to achieve with our support

Our support for communication may include: 

• Education to help you understand why your communication has changed
• Advice on how to make communication easier between you and others 
• Techniques to help improve your speech or language skills  
• Communication partner training 
• Invitation to a speech group  
• Onward referral to other specialist services e.g. Newcastle University Aphasia Centre 
• Signposting to further support e.g. Parkinson’s disease groups in the local area  

Our support for swallowing may include: 

• Education about your diagnosis to help you understand why your swallowing has changed  
• Techniques and advice on how to help improve the safety or comfort of swallowing  
• Exercises to strengthen the muscles used in swallowing  
• Talking about the risks of your swallowing problem so that you can make an informed decision about what you want to eat and drink 
• Talking about other methods of eating e.g. a feeding tube  
• Trying different utensils that can help eating and drinking 
• Onward referral to other specialist services e.g. gastroenterology 
• Signposting to further support e.g. International Dysphagia Diet Standardisation Initiative (IDDSI)

It depends on your condition. You may only require 1 appointment.

We will talk about the length of treatment with you in your assessment appointment.

Unfortunately, it is not always possible to get rid of your communication or swallowing problems completely.

We will offer you rehab where appropriate. But sometimes the SLT will help you adjust to your ‘new normal’. They will give you knowledge and support to learn to cope with any ongoing problems. This is to help you maximise your comfort and quality of life.

Contact number: 0191 293 3001

We offer appointments:

• in outpatient clinics
• in nursing homes
• by home visit if needed
• by telephone or video call

Clinic locations

• Alnwick Community Hospital
• Berwick Infirmary
• Blyth Community Hospital
• Hexham General Hospital
• Morpeth NHS Centre
• Oxford Centre, West Avenue, Longbenton, NE12 8LT 

Video-fluoroscopy clinic locations

This is a specialist swallowing assessment by referral only.  

• Hexham General Hospital
• North Tyneside Hospital

Attendance

Please let us know as soon as possible if you can't come to an appointment or no longer wish to continue with therapy.

If you miss an appointment without telling us, we will write to you to ask you to contact us within 1 month for a new appointment. If we do not hear from you, we will discharge you from the service.

Missed appointments cost the NHS money and can delay treatment to you or others on the waiting list. If you repeatedly cancel within 24 hours of your appointment within your planned treatment period, we will discharge you.