Charitable Funds Committee. Speech and Language Therapy Bids 2011

Transcription

1 Charitable Fund Committee Speech and Language Therapy Bids 2011 AGENDA ITEM 5.1 Priority Proposal Number 1 Purchase and use of the Lee Silverman Voice Therapy Companion: Clinician Edition within Speech and Language Therapy (SLT). 2 Purchase of 1 x SL40 Lightwriter for patients with acquired communication disorders in the community. 3 Purchase of 9 x Tru Tone Servox communication aids for patients who have undergone laryngectomy 4 Purchase of 4 x E-Tran Frames for patients with severe brain injury 5 Purchase of Patient Fridge for storage of food and equipment for use within the UHW Videofluoroscopy Clinic and Speech and Language Therapy UHW out-patient clinics. Cost ( ) 500 4,500 4, Total 9,980 1

2 Title of Proposal: Purchase and use of the Lee Silverman Voice Therapy Companion: Clinician Edition within Speech and Language Therapy (SLT) Evidence for Proposal: Lee Silverman Voice Therapy (LSVT) is a treatment technique used with patients with voice disorders, predominantly those with Parkinson s Disease. It focuses on increasing vocal volume by training individuals both to speak louder and judge their loudness accurately, thereby improving intelligibility of speech. There is evidence that vocal intensity during sustained voice production and within reading significantly increases following LSVT (El- Sharkawi, 2002). Moreover, LVST is recognized as best practice (Royal College of Speech and Language Therapists (RCSLT), 2009). In 2010, the Department of SLT extended the skill mix within the department to enable patient access to LSVT, hitherto unavailable across the University Health Board (UHB). Sessions now run regularly at Rookwood Hospital and will continue after the move to St. David s Hospital with plans to extend across the UHB. At present, SLT staff collate patient vocal data manually which is time-consuming and reduces the amount of clinical contact time. The LSVT COMPANION is a recent invention, hitherto used little within the UK. It would improve the quality of intervention offered to patients. References El-Sharkawi, A., Ramig, L., Logemann, J., Pauloski, B., Rademaker, A., Smith, C., Pawlas, A., Baum, S., and Werner, C.. (2002). Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT ): A pilot study. Journal of Neurology, Neurosurgery, and Psychiatry, 71, Royal College of Speech and Language Therapists (2009). RCSLT Resource Manual for Commissioning and Planning Services for SLCN: Voice. London: Royal College of Speech and Language Therapists Description of Proposal: The LSVT COMPANION is a dedicated computer software package which enables speedy and rigorous data collation of patient performance within therapy sessions. Measuring client vocal performance during treatment and tracking progress over time can be time consuming and challenging for the clinician. The LSVT COMPANION automates treatment data collection, enabling the clinician to focus on the patient and efficiently deliver the clinically proven LSVT treatment. It enables fast and easy capture and collation of treatment data providing opportunities to increase patient throughput. It displays key measures including sound pressure level (loudness), frequency (pitch) and duration as the patient performs voice and 2

3 speech exercises. Estimated Costs: 500 including package and posting How we will evaluate the benefits to patients: Purchase and use of the LSVT COMPANION will improve the patient s experience of both their SLT and their own management of their condition. The themes identified by the Board through the Quality and Safety Committee will underpin SLT evaluation of the impact of the LSVT COMPANION through use of the methods described below: First and lasting impressions: the LSVT COMPANION will offer patients an innovative approach to treatment. It will give variety to an otherwise repetitive kind of therapy, thereby enhancing their experience. It will promote independence (patients can operate the software on their own) enhancing the opportunity for better carryover outside clinic. SLT will measure these features through administration of a Patient Experience Questionnaire. Safe, Supportive environment: LSVT supports patients by promoting return of vocal performance to near normal limits, thereby improving communication. There are widespread benefits associated with this, for example re-access to work and better performance within this. A number of tools are available within the LSVT COMPANION to evaluate these benefits, namely: 1. A Pre- and Post-Functional Rating Scale 2. A Voice Handicap Index 3. Partner Perceptual scales 4. Decibel Metre Readings 5. Pre- and post- Video Clips Information and involvement: Patients will be able to access visual electronic data through Real Time Performance Line Graphing. They respond well to immediate visual feedback on their repetitions and this objective measure will help dramatically with the calibration process, increasing their access to information. Moreover, they will become more independent, operating the PC software programme themselves. This will offer patients more information about how they are progressing and enable them to personalize their own goals. SLT will evaluate these impacts via informal semi-structured interviews pre- and post- treatment Submitted by: Ruth Nieuwenhuis: Head of Adult Speech and Language Therapy Date: 1 March

4 Title of Proposal: Purchase of 1 x SL40 Lightwriter for patients with acquired communication disorders in the community. Evidence for Proposal Best evidence indicates that those with communication difficulties should have access to specialist aids in order to maximize their opportunities to communicate and interface with others (Royal College of Speech and Language Therapists, 2009). With the growth of community services and the success of the Cardiff East Locality Team (CELT) (Department of Speech and Language Therapy, 2009), there have been an increasing number of patients identified with communication impairment within the community. The department has a small bank of aids but insufficient funding to purchase additional expensive items for this new cohort of patients. At present, it relies on the Communication Aids Centre for short-term loan of aids but this entails a delay as there is a waiting list. The department also accesses aids via other sources, e.g. the Motor Neurone Disease Association. Nevertheless, there is inevitably a waiting list during which period the patient suffers from lack of appropriate communicative access. References Department of Speech and Language Therapy (2009). Cardiff East Locality Team (CELT) Speech and Language Therapy Report: September 2008 March Cardiff and Vale University Health Board: Department of Speech and Language Therapy. Royal College of Speech and Language Therapists (2009). RCSLT Resource Manual for Commissioning and Planning Services for SLCN: Dysarthria. London: Royal College of Speech and Language Therapists. Estimated Costs: 4,500 including postage and packing How we will evaluate the benefits to patients: Purchase and use of the SL40 Lightwriter will improve the patient s experience of both their SLT and their own management of their condition. The themes identified by the Board through the Quality and Safety Committee will underpin SLT evaluation of the impact of the SL40 through use of the methods described below:. 4

5 First and lasting impressions: the SL40 will be available for immediate short term loan within the community, with the SLT able to take the aid to the patient on the first domiciliary visit. Rapid access, hitherto unavailable, will enhance communication from the outset. Thereafter, the SLT will be able to approach other agencies as before (e.g. the Motor Neurone Disease Association) for longer term loan. SLT will measure this impact via a count of the number of times the SL40 is taken, used, and left with the patient on the first domiciliary visit. Safe and Supportive Environment: patients who live alone and who have communication impairment are often unable to give information easily to their SLT. Use of the SL40 will enable the SLT to glean important information from the patient about key features such as swallowing difficulties experienced, comfort, opinion about their care environment and so forth. It also provides the means to assess mental capacity. Furthermore, the text, phone and function of the SL40 enhance opportunities for patients to call for attention in the case of emergency and to communicate with the outside world. SLT will measure these parameters through use of a patient questionnaire. Information and involvement: the SL40 provides the patient with a means of participating more broadly within society by improving access to the outside world. An example of its use in the past within CELT includes negotiations with a solicitor who was unable to understand the patient s views with regard to divorce proceedings. Use of a Lightwriter borrowed from the Communication Aids Centre enabled in-depth communication about the patients views. In addition, the saved messages function on the device enables speedy transfer of information and the use of the aid as a memory trigger where appropriate allows the patient to become more involved with their care. SLT will measure the impact of these benefits by collating the number of messages saved and via use of a patient questionnaire. Submitted by: Ruth Nieuwenhuis: Head of Adult Speech and Language Therapy Date: 1 March

6 Title of Proposal: Purchase of 9 x Tru Tone Servox communication aids for patients who have undergone laryngectomy Evidence for Proposal Following prolonged multimodality treatments for head and neck cancer, there are many physiological and structural changes that affect the individual s ability to communicate, to speak, to use their voice, to eat and/or swallow, smell, breath, to interact socially and to fulfil work capabilities. The loss of the ability to communicate and to swallow has major psychological impacts on the individual and their concept of self (Royal College of Speech and Language Therapists, 2009). Loss of communication can be a shock and cause upset to patient and their family resulting in a period of grief (denial, anger, bargaining, and frustration). The individual may experience feelings of isolation with the loss of personal relationships, loss of work, economic security, home and independence (Fox and Rau 2001). References Fox, L. and Rau, M. (2001). Augmentative and alternative communication for adults following glossectomy and laryngeal surgery. AAC Augmentative and Alternative Communication, 17 (3), pp Royal College of Speech and Language Therapists (2009). RCSLT Resource Manual for Commissioning and Planning Services for SLCN: Head and Neck Cancer. London: Royal College of Speech and Language Therapists. Description of Proposal The Department of Speech and Language Therapy (SLT) at UHW has 24 Servox artificial larynxes, battery operated hand-held devices that vibrate air in the oral cavity when held to the neck. These cost 500 each and stock must be continually replenished because patients have them on long term loan. Moreover, the aids are occasionally dropped by patients accidentally and must be sent off for expensive repair. Negotiations are on-going within the University Health Board (UHB) regarding cheaper in-house repair options. The SLT department purchases four Servox devices annually at a cost of around However, stock remains low and the risk remains that available equipment will run out. Estimated Costs 4,500 including postage and packing 6

7 Title of Proposal: How we will evaluate the benefits to patients: Purchase of 4 x E-Tran Frames for patients with severe brain injury The themes identified by the Board through the Quality and Safety Committee will underpin SLT evaluation of the impact of the Tru Tone Servox devices through use of the methods described below:. First and lasting impressions: Head and Neck cancer patients will be able to trial a Servox when needed and these will be available for immediate short term loan where clinically indicated. A replenished store will enhance patients access to these communication aids from the outset and will enable the Head and Neck SLTs to ensure that borrowing is equitable throughout the University Health Board (UHB). SLT will measure these benefits by maintaining a log of the number of Servox devices on loan, the number sent for repair, and the waiting time experienced by patients. Safe and Supportive Environment: patients who live alone and have undergone laryngectomy are vulnerable because of their inability to communicate readily, particularly in an emergency. Ready access and long term loan of a Servox will reduce this risk, contributing to their safety and providing a more supportive environment. Some may be able to re-access work opportunities. SLT will measure these parameters through use of patient questionnaires. Information and involvement: the Servox provides the patient with a means of participating more broadly within society by improving access to the outside world. Again, SLT will measure the impact of this via use of a patient questionnaire. Submitted by: Ruth Nieuwenhuis: Head of Adult Speech and Language Therapy Date: 1 March

8 Evidence for Proposal: Patients with severe brain injury, and in particular, locked-in syndrome, may rely solely on eye-pointing to communicate their needs The use of an E-Tran frame is often the only means of communicating with the outside world. It is system of communication that is used to supplement or replace speech, to help people with oral communication impairments to communicate (Royal College of Speech and Language Therapists (RCSLT), 2009). The E-Tran consists of a low-tech clear perspex rectangular communication aid with the alphabet is grouped into each of the aid s four corners. Each of the letters is a different colour and discs of these six colours are arranged around an open hole, a window in the centre of the frame. This window enables the user and the communication partner to see each other clearly. The frame is held by the communication partner about 18 inches in front of the user s face at eye-level. The user looks where the letter they wish to communicate is positioned and then to the corresponding colour of that letter. The communication partner confirms each letter and keeps a note of what is being communicated. The objective of introducing alternative and augmentative communication such as an E-Tran frame is to maximise communicative function in those areas of life that are seen as a priority by the individual and their family (Clarke et al. 2001). The influx of young patients to UHW with H1N1 flu to intensive care over the past few months has led to an increase in referrals to Speech and Language Therapy of patients who can communicate only via eye movements. This has stretched the demand on the use of E-Tran frames within intensive care. The department has four frames, three of which are currently in use at UHW by patients with H1N1 flu and by their relatives and carers. Additional stock would ensure availability of further frames if needed. References Clarke, M., McConachie, H., Price, K., Wood, P Views of young people using augmentative and alternative communication systems. International Journal of Language and Communication Disorders, 36, 1, Royal College of Speech and Language Therapists (2009). RCSLT Resource Manual for Commissioning and Planning Services for SLCN: Brain Injury. London: Royal College of Speech and Language Therapists. Description of Proposal Through purchase of four supplementary E-Tran frames, patients admitted to intensive care and on the brain injury wards will have access to communication through their eye-pointing system. The SLT team will be able to train relatives and carers how to use the frame effectively. 8

9 Estimated Costs: 380 including package and posting How we will evaluate the benefits to patients: Purchase of the E-Tran fames will improve the patient s experience whilst on intensive care and also those of their relatives and carers. The themes identified by the Board through the Quality and Safety Committee will underpin SLT evaluation of the impact of E-Tran use through the methods described below: First and lasting impressions: by using eye-pointing, staff and relatives are able to make immediate contact with someone with whom they cannot communicate. This individual regains access to the outside world via use of the E-Tran system. The SLT department will evaluate the impact by recording the number of times the E-Tran frames are used successfully by patients and carers. Safe, Supportive environment: the E-Tran frame provides the patient with access to a system whereby they can communicate their needs, any pain or discomfort, unhappiness, or distress. In addition, it enables staff to ensure they have gained informed consent from patients before they embark on intensive care procedures with them. The SLT department will evaluate this impact by use of patient/relative and staff questionnaires. Information and involvement: the E-Tran frame is vital when assessing an individual s mental capacity and has been used in this way with brain injured patients (e.g. when ascertaining testamentary capacity). It also enables them to be involved in their treatment plan, offering them the opportunity to ask about their prognosis and their condition. Again, the SLT department will evaluate this impact by use of patient/relative and staff questionnaires. Submitted by: Ruth Nieuwenhuis: Head of Adult Speech and Language Therapy Date: 1 March

10 Title of Proposal: Purchase of Patient Fridge for storage of food and equipment for use within the UHW Videofluoroscopy Clinic and Speech and Language Therapy (SLT) UHW out-patient clinics. Evidence for Proposal: SLT runs a Videofluoroscopy clinic within the Department of Radiology in partnership with Consultant Radiologists and the Department of Radiography. During this, an SLT offers specific food and drink to patients with swallowing difficulties in order to evaluate the competency of their swallowing mechanism. Parellel clinical assessment takes place within the SLT outpatient department at UHW with additional food and drink substances as clinically indicated. At present, SLT has to use the staff fridge to store these. Guidelines indicate that patient food and drink should be stored in a dedicated patient fridge (Department of Occupational Therapy, 2008). References Department of Occupational Therapy (2008). Food Hygiene Guidelines for Rehabilitation and Therapeutic Cooking Areas. Department of Occupational Therapy: Cardiff and Vale NHS Trust (latest version). Description of Proposal The use of a dedicated patient fridge will enable SLT to adhere to best practice with regard to food hygiene for rehabilitation and therapeutic cooking areas. Estimated Costs: 100 including package and posting How we will evaluate the benefits to patients: Purchase of a fridge will improve the patient s experience within the videofluoroscopy clinic and out-patient clinic. The themes identified by the Board through the Quality and Safety Committee will underpin SLT evaluation of this impact through use of the methods described below: First and lasting impressions: patients attending out-patient SLT will see that the food and drink they are to be given is stored within a dedicated patient fridge within the out-patient clinic. This will create a positive impression about the standards maintained within the department. 10

11 Safe, Supportive environment: greater rigour with regard to food and drink storage will reduce any potential risk to patients regarding food and drink contamination. Information and involvement: those patients who prefer and need to be tested with their own choice of food and drink will be able to store these if necessary within the patient fridge. Benefits will be evaluated via audit of standards for food and drink hygiene. Submitted by: Ruth Nieuwenhuis: Head of Adult Speech and Language Therapy Date: 1 March