Overview
The Speech and Language Therapists (SLTs) work as an integral part of multidisciplinary teams caring for patients with head and neck cancers and brain tumours.
In head and neck cancers, SLTs assess and treat communication and swallowing problems, before and after surgery and/or radiotherapy, helping to resolve these difficulties as much as possible. SLTs also support non-oral feeding, alternative and augmentative communication and palliative care.
Brain tumours in certain parts of the brain may affect speech and/or swallowing. The main areas involved are:
- Frontal lobe: A tumour in the frontal lobe may cause changes in personality, thinking and speech difficulties.
- Parietal lobe: A tumour in the parietal lobe may cause difficulty with reading, writing, speaking and/or understanding words.
- Temporal lobe: A tumour in the temporal lobe may cause speech and memory difficulties.
- Cerebellum: A tumour in the cerebellum is likely to cause difficulties with speech coordination (Dysarthria).
- Brain stem: A tumour in the brain stem may cause speech and swallowing difficulties due to facial weakness and affect control of movements needed for swallowing.
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Specific Speech and Language Therapy Management
Personality and Cognitive Changes
A speech and language therapist may work in collaboration with other health professionals to help patients experiencing personality changes or cognitive problems.
Speaking
Patients with brain tumours may have difficulty speaking words. Some patients may have motor-speech difficulties (Dysarthria, Dyspraxia) whereas others may have word-finding difficulties (Dyspasia).
There are a number of techniques to help with word retrieval, which are usually practised in therapy sessions and at home. The therapist may also provide strategies for patients on what to do when they are unable to retrieve a word, and for family/carers on how to maximise communication, which can include the use of gestures, drawing and writing to effectively communicate.
Understanding
Patients with a parietal lobe tumour may have difficulty understanding language. There are a number of approaches to help improve understanding, including practising spoken words to picture matching. The patient’s family/carers can also be given strategies to help understanding, for example, using gesture and drawing to accompany their speech.
Motor Speech Difficulties
Dysarthria is common in patients with a cerebellar or brain stem tumour. An adult with dysarthria will be given a programme of exercises to improve the strength, range of movement and co-ordination of speech. Other techniques include use of strategies to help improve intelligibility for example, a communication board with pictures/photographs that they can point to, or a communication book which can be designed with both patient and family members to make it a useful communication aid.
Swallowing
Treatment for swallowing difficulties always includes the following two goals: safety and efficiency.
Postural changes alter the dimensions of the throat and/or the gravitational flow of food. They increase efficiency of swallowing and reduce the risk of inhaling food. Postural changes may include:
- Head turn
- Head tip
- Chin down
- Head back.
Increasing sensory characteristics of the food, for example, temperature and taste can also help. Food that has to be chewed, or drinking from a straw, increase intra-oral pressure and also increase sensation.
Thicker foods and/or liquids may be advised in patients with a delay in their swallowing reflexes.
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Oral Cancer
A pre-treatment assessment is useful in providing a baseline of the patient’s ability, which provides a post-treatment comparison. Both speech and swallowing can be affected.
Acute side affects of radiotherapy such as dryness in the mouth and throat, inflammation, ulcers, changes in taste and smell all affect the patient’s ability to initiate swallowing.
Speech rehabilitation maximises residual function. A programme of exercises may be given to the patient to practise in and outside of speech and language therapy sessions which aim to increase range of movement, co-ordination and strength.
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Laryngeal Cancer
Voice Care (Symptom Management)
Following radiotherapy patients can be given the following advice to manage the side-affects:
- Encourage adequate hydration:
- Drinking plenty of water and fluids
- Use steam inhalations
- Discourage/avoid:
- Smoking and smoky atmospheres
- Spirits and alcohol
- Caffeine
- Spicy food
Laryngectomy
Following complete removal of the larynx, a SLT can help by teaching the patient oesophageal voice, tracheo-oesophageal voice or to use an electro-larynx.
Oesophageal voice is initiated by a column of air in the oesophagus (gullet) which is pushed through the throat. This technique can be difficult to learn and produces a low volume voice. It is an effective method, if used, but very few patients achieve it.
Tracheo-oesophageal voice is made possible by a one-way silicon valve inserted surgically. This method is the nearest artificial means to normal voice.
An electro-larynx is not commonly used. However, it can be easier to learn than oesophageal voice. The patient holds a battery powered vibrating membrane to the throat. This method is often used immediately following surgery.
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