For Whānau » Resources for Whānau and Carers

The New Zealand Speech-language Therapists' Association has a range of information sheets on several important topics.  This page is a work in progress - we aim to build the number of topics covered.

If you cannot find information on a specific topic, contact the Association.

Fact Sheets

Loss of hearing may be mild, moderate, severe, or profound.

There are two main types of hearing loss:

  • Conductive hearing loss: sound is prevented from travelling through the outer and/or middle ear through to the inner ear
  • Sensorineural hearing loss: the inner ear or auditory nerve has suffered damage so that messages cannot be passed on to the brain

Characteristics

There are several characteristics associated with hearing loss. These may include:

  • difficulty hearing conversation within a group of people (e.g., at meetings or social gatherings)
  • difficulty hearing high-pitched sounds (e.g., the telephone ringing)
  • difficulty hearing others over the telephone
  • frequent misunderstandings
  • frequent requests for repetitions of words or phrases
  • difficulty hearing in public places where sounds sources are at a distance away from the listener (e.g., at church)
  • children with hearing loss may omit certain sounds in speech or may have difficulty understanding what is said to them

Causes

There may be several causes of hearing loss in individuals. Common causes may include:

  • exposure to loud noise
  • family history
  • middle ear infections (glue ear)
  • the natural aging processes
  • illness or congenital disabilities

Role of the Speech-language Therapist

The degree to which a speech-language therapist may be involved in cases of hearing loss varies. However, their role may include one or some of the following:

  • administering an initial hearing screening
  • referring to an audiologist for a comprehensive hearing assessment
  • intervention to support communication development
  • provision of communication strategies for individuals with hearing loss
  • provision of strategies for coping with background noise, lighting, and distance
  • assisting with the treatment of children with auditory processing disorder (APD)
  • provision of information about the prevention of hearing-related communication and language disorders

What you can do

If you know someone who has a hearing loss, try using the following strategies to assist them in their communication:

  • look directly at the person when speaking
  • speak clearly and not too quickly in a normal tone of voice
  • do not shout
  • do not exaggerate your lip movements
  • reduce background noise and visual distractions
  • reduce the distance between you and the person with a hearing loss
  • ensure there is sufficient lighting to support lip-reading (where appropriate)
  • if the person does not understand, reword your sentence rather than repeat it
  • be patient when misunderstandings occur

 More Information

For more information about hearing loss or for contacting a speech-language therapist, try getting in touch with one of the following:

  • local audiologist
  • local doctor
  • the Yellow Pages
  • Massey University Speech-language Therapy Clinic: (09) 414 0800 ext. 41290 / 41277
  • the University of Auckland Speech-language Therapy Clinics: (09) 303 5979
  • the University of Canterbury Speech and Hearing Clinic: (03) 364 2408
  • the NZSTA Private Practice Directory

Useful contacts

The New Zealand Audiological Society (NZAS)
E: admin@audiology.org.nz
P: 0800 625 166 (freephone in NZ only)

P: +64 9 817 9498
www.audiology.org.nz

 National Foundation for the Deaf and Hard of Hearing
E:  enquiries@nfd.org.nz
P: 0800 867 446 (freephone in NZ only)
www.nfd.org.nz/

A laryngectomy is the surgical removal of the larynx (voice box). Most laryngectomies are performed on individuals who have cancer of the larynx. Laryngectomies may also be performed as a measure to help people breathe.

When the larynx is removed, there is no longer a connection between the mouth and the lungs. Consequently, individuals who undergo a laryngectomy breathe, cough, and sneeze through an opening in their neck (called a "stoma") created during surgery.

A laryngectomy affects breathing, talking and swallowing. Speech-language therapists support individuals in all these areas.

Effects on Voice

When a laryngectomy is performed, the most significant loss is often the loss of voice. In normal speech, the voice is the sound produced by the larynx. Sound travels up to the mouth, where the sounds needed for speech are formed. When an individual undergoes a laryngectomy, the source for voice is lost. However, surgery does not affect the ability to coordinate the lips, tongue, and palate (for speech).

Role of the Speech-language Therapist

In working with individuals who have undergone a laryngectomy, the speech-language therapist's main role is to help the individual communicate using an alternative source. There are ways in which this is done:

  • Writing and text-to-speech: for some, and in some circumstances, writing and text-to-speech options may be used instead of speaking.
  • Oesophageal speech: the individual learns to squeeze air down into the oesophagus (food tube) and then bring it up in a controlled fashion, causing the muscles at the top of the oesophagus to vibrate and produce sound for speech.
  • Tracheo-oesophageal prosthesis: a valve is inserted between holes in the trachea (windpipe) and oesophagus, allowing air to pass from the lungs to the oesophagus. The valve is one-way and does not allow food to pass from the oesophagus to the lungs. When the patient breathes out and covers the stoma (opening) with a finger or hands-free with a specialised valve, the air is forced through the muscles at the top of the oesophagus, which then vibrates, producing a sound source that can be used for speech.
  • Electro-larynx: This is a small instrument that makes a noise when you press a button. When the electro-larynx is held firmly against the neck or through a tube into the mouth, sound can be delivered to the lips, tongue, and palate to produce speech.

What you can do

There are several 'dos' and 'don'ts' for communicating with an individual who has undergone a laryngectomy. These include the following:

  • understand the person's need to express their feelings
  • be patient and wait for the person to talk
  • allow the person to speak for themselves
  • encourage the person to practice any speech exercises for short but frequent periods
  • encourage the person to speak slowly
  • help the person to keep active with friends
  • find out about mouth-to-neck resuscitation
  • do not overprotect the person
  • do not anticipate the person's needs
  • do not speak for the person
  • do not 'nag' the person to practice
  • do not encourage whispering
  • try not to expose the person to dust, smoke, fumes, or extremes of temperature

 More Information

For more information about laryngectomy or to contact a speech-language therapist, try contacting one of the following:

  • your doctor
  • your local hospital
  • the Yellow Pages
  • Massey University Speech-language Therapy Clinic: (09) 414 0800 ext 41290 / 41277
  • the University of Auckland Speech-language Therapy Clinics: (09) 303 5979
  • the University of Canterbury Speech and Hearing Clinic: (03) 364 2408
  • the NZSTA Private Practice Directory
  • your local hospital's Ear Nose and Throat clinic

 Useful contacts

SLTs play a key role in determining a person’s mental capacity (ability to make decisions) and supporting decision-making.

This fact sheet outlines a speech-language therapist’s role in the assessment of a person’s mental capacity.

What you need to know about COVID-19, including the latest information and advice from the Ministry of Health.

For COVID-19 health advice, call 0800 358 5453 anytime.

Follow the links to World Health Organisation's short animations (1/2 min) on the following topics

Techniques to manage breathlessness

Managing eating, drinking and swallowing

Managing problems of voice

Managing activities of daily living

Exercises after illness

Managing problems with attention, memory and thinking

Palliative care is an approach to optimise the quality of life and mitigate suffering among people with serious, complex, and sometimes terminal illnesses.

Speech-language therapists look after people with disruptions in their communication and secretion management (too much saliva - too little swallowing, poor lips seal or too little saliva - the effects of medication, radiation treatment, posture) and oral care and difficulties with swallowing. 

All these things are very relevant as health conditions change

Speech-language therapists can help with assessment, advice, and guidance.

Sometimes exercise is useful or compensation. Sometimes equipment or the encouragement to let you know that the great skills you and your loved one have worked out “are simply the best “and match needs perfectly.

Below are some things you might be experiencing and some you could expect from your therapist. 

Keep in touch with them as things change for you or your loved one. 

Matching resources to need is the Speech therapists’ bread and butter! 

Communication

Language: Aphasia is well known when it occurs with a stroke, but this may also happen when any part of the brain is damaged surgically, or there are disruptions to language this can include socialising, remembering, concentrating, understanding, and using body language and gestures, reading, writing, talking and understanding speech.

Speech-language therapists are trained to help assess where the communication disruption or breakdown occurs and develop a plan with the person, their family, and listeners to work out how best to keep the loved one message passing through their journey.

Sound clarity: You may find that your medical team mention the word dysarthria. This refers to a disruption of sound production, whether muscles of the lips and tongue are not working to create perfectly recognised sounds or the loudness may be disrupted in a person, for example, who has Huntington's disease, motor neurone disease, or head and neck cancer. 

Your speech therapist may help you with strategies to increase clarity, avoid communication breakdowns, and reduce frustration.

Communication aides 

Essential to our connexion with each other is our need to successfully message pass, which may need a change from speech; to a device, a whiteboard, paper and pen, texting or emails. Endorsing solution finding is important, and it may be that different techniques are used in different settings, for example 

  1. a pre-prepared typed script for a doctor’s appointment
  2. an email replacing a phone call
  3. the use of Zoom or Skype with loved ones overseas using the chat box writing option
  4. also, all the benefits of seeing the person's face help communication.

The speech therapist needs to match the equipment with the changes the person experiences sometimes, high-tech devices are useful, but other times, simple things make the difference.

  • Yes/no questions 
  • forced choices, e.g. soup or omelette.
  • keyword spelling with an alphabet chart.
  • Thumbs up or down 
  • Look left for yes. 
  • Squeeze my hand for No.

Thinking or cognitive difficulties

Surgical intervention or radiotherapy, or the disease process itself, may change the person's ability to think; this may include impaired memory, understanding of subtle language, like jokes and a reduction in the person's ability to problem solve. Useful things to help include:

  1. talking in a short, clear sentence and avoiding rushing or completing the sentence for them
  2. allowing extra time, making sure that complex conversations are held when they are not tired, or you stop if you notice that they fatigue
  3. encourage your loved one to be as independent as possible but assist if needed
  4. promote communication even if it takes a long time, let the person know that what they must communicate their message is important to you.
  5. be aware of the person's sense of loss and frustration this may not be directed at you it may be directed at their personal changes

There may be a loss of insight into their thinking function, and you, the listener, can be perceived as the bad guy because you are raising their awareness of their functional change. Note this and allow for your loved one’s adjustment.

 

Swallowing (known as Dysphagia)

Changes in your swallowing ability may be an integral part of the disease change. in the case of motor neurone disease or Parkinson's disease or because of management of the condition, for example, radiation treatment for head and neck cancer. This will affect the following:

  • quality of life
  • possibly your weight 
  • the amount of fluid that you can drink 
  • how successful your bowel motions are during a day if you have become dehydrated 
  • your saliva flow
  • Your ability to eat certain foods
  • your ability to eat at all or to drink

Speech therapists are there to help you work out good solutions to these challenges; these might include special cups or spoons, thickened drinks, high-calorie drinks in liaison with the dietitians, positioning in conjunction with the occupational therapists and physiotherapists, mouth cares that you, can help the Hospice nurse with.

If you are unable to eat anything or drink anything and have made a choice not to put anything in your mouth, good mouth cares are still important; simple things like lip balms, bicarbonate of soda swabs and fine-flavoured wafers from supermarkets will improve your quality of life and make your breath smell and taste pleasant.

 

Advanced care planning and legacy work

If your speech therapist has journeyed with you for a long time, she might have been part of your decision-making about eating with known risk or part of your advanced care planning. (ACP)

If you are meeting the speech therapist in the closing chapter of your life, it may be a worthwhile topic to bring up both these ideas are about keeping the person with the disease in charge and acknowledging their wishes. This makes a difference in the quality of life.

In planning for the closing phase of one's life, you may also have considered leaving written letters, typed emails & recorded messages for your loved ones. 

There's an online app called record me now, a place to store electronic recordings thoughtfully. 

Legacy activities, collage boards and memory-making activities are also very therapeutic in their production and helpful for those left behind after their loved one has passed. 

There are several books online and in libraries that may help with difficult conversations with younger family members, such as thestoryofthesandman.com website (a picture book story poem by Glen Colhoun). 

Seasons for Growth is an 8-week programme for children, young people or adults who have experienced loss or grief.

 

A stroke is caused by a sudden interruption in the blood supply to parts of the brain, preventing the adequate provision of oxygen and causing those areas of the brain to be damaged. Strokes can take the form of a haemorrhagic stroke (bleeding in the brain) or an ischemic stroke (a blockage of an artery feeding into the brain).

Some of the brain’s functions can be related to specific regions; for example, the motor cortex on each side of the brain controls movement on the opposite side of the body (so damage to the left side of the brain can cause movement difficulties on the right side of the body). Other brain functions relate to networks of different structures connected across the brain.  Language functions, including finding words, putting sentences together, understanding conversations and reading and writing, include both specific structures, mostly on the left side of the brain, and networks connecting many other brain areas. This means that strokes in many different brain areas can result in changes to speech and language functions. Many people find that post-stroke fatigue can also affect their speech and language. 

Speech Difficulties following a Stroke

Dysarthria is the name given to speech changes from weakness or reduced control of the muscles used in breathing and speaking. Dysarthria can result in slurred and distorted speech and be too fast or too slow. 

Changes to the way the voice sounds is called dysphonia. This can include a very quiet, weak or breathy voice or a hoarse/strained voice. 

Some people also experience difficulties sequencing and coordinating the muscles that produce speech sounds. This is called apraxia of speech.  

Language Difficulties following a Stroke

Aphasia is the umbrella term used to describe changes to language functions after stroke or other kinds of brain injury. There are different types of aphasia, and individuals may have difficulty with a range of language skills, including finding names, putting their thoughts into words, understanding what is said, understanding jokes/sarcasm/hints, following and taking part in conversations, reading, writing, and using numbers. Some people with aphasia may only have difficulty with one aspect of language, but some may have difficulties with many or all areas of language.

Role of the Speech-language Therapist

Speech-language therapists play an important role in assessing and treating communication disorders following a stroke. Some of their tasks may include:

  • assessment and diagnosis of speech and/or language difficulties
  • working with the individual, their whānau/carers, and their wider communities and social networks,
  • liaising with the other health professionals involved. 
  • establishing treatment/management plans specifically for the individual
  • maximising the person’s ability to communicate independently
  • referring to other organisations or agencies where appropriate
  • supporting and advising whānau on the best way to communicate with the person who has had a stroke.

 What you can do

You can use several strategies to facilitate communication with individuals who have suffered a stroke. These include:

  • please keep including the person with speech/language changes in whānau and social events, and support them to engage with the people and activities they value.
  • provide opportunities for one-to-one conversation as group conversations may be harder
  • keep background noise to a minimum
  • face the person when speaking to them
  • allow the person plenty of time to respond
  • use short, straightforward sentences using a steady pace (don’t speak too quickly)
  • talk to the person rather than about them
  • accept and encourage all means of communication, including gestures and facial expressions. If they have a communication book or aid, please use this with them.
  • find out from your speech-language therapist about the person’s communication difficulty and the best way to communicate with them. 

More Information

For more information about speech and/or language difficulties following a stroke or to contact a speech-language therapist:

Difficulties with swallowing are known as dysphagia.  Dysphagia describes when there is difficulty moving food or liquid safely from the mouth to the stomach.  Food or drink may pass into the trachea (windpipe) and then into the lungs instead of the stomach.  This may obstruct the airway, cause coughing and may result in choking or pneumonia.  In some cases, food might move slowly, or 'stick', or liquid may be regurgitated into the nose. Dysphagia can be dangerous, unpleasant and/or affect mealtime speed and enjoyment.

Swallowing difficulties may occur at any age for various reasons (see below).

In children, dysphagia is often called paediatric feeding disorder (PFD).

Characteristics

Several signs may indicate or suggest a swallowing difficulty.  These include:

  • coughing or choking when eating or drinking
  • unexplained coughing or choking after meals
  • a gurgly sounding voice after eating or drinking
  • a feeling of food stuck in the throat after swallowing
  • difficulty chewing and controlling food in the mouth
  • taking a long time to finish a meal
  • needing to swallow several times to clear each mouthful of food
  • excessive drooling, especially immediately after meals

 Other signs that may be noticed after a while may include:

  • repeated chest infections
  • unexplained weight loss
  • loss of appetite
  • fear of eating

Causes

There are many causes of dysphagia, which include:

  • a neurological disorder that affects the control of the muscles of swallowing (e.g., stroke, motor neurone disease, cerebral palsy, Parkinson's Disease, or multiple sclerosis)
  • a congenital abnormality  that affects the swallowing structures (e.g. cleft palate)
  • surgery to the head, neck, or oesophagus (food tube)
  • an illness or injury to the head, neck, throat, or oesophagus (e.g. trauma or cancer of the tongue)
  • presence of a tracheostomy tube

Some swallowing problems may improve with time or medical/surgical interventions. Some may gradually get worse depending on their underlying cause. Some can be successfully treated with speech-language therapy.

Role of the Speech-language Therapist

Following a referral, the speech-language therapist will assess an individual's swallow and identify the severity of the problem and the underlying biomechanical differences present. They may recommend interventions including various compensatory strategies such as diet texture modifications and adaptations to feeds/mealtimes. If rehabilitation is appropriate, the speech-language therapist will design and support the individual through a rehabilitation exercise programme tailored to the specific swallowing difficulties and their cause. The speech-language therapist will then monitor progress.

The speech-language therapist will liaise with the individual, family/carers, and members of the swallowing team and will make appropriate referrals (e.g., dietician or neurologist).

What you can do

If you, or someone you know, has difficulty swallowing, seek professional advice from your local doctor or hospital.  There are many reasons swallowing difficulties may exist, and it is important to investigate underlying causes as soon as possible.

Avoid any food or liquid that is difficult to swallow until you see a speech-language therapist.

Ask your nurse or doctor to teach you how to use the Heimlich manoeuvre safely.

More Information

For more information about dysphagia or to contact a speech-language therapist, please consult:

  • your doctor
  • your local hospital
  • the Yellow Pages
  • Massey University Speech-language Therapy Clinic: (09) 414 0800 ext 41290 / 41277
  • the University of Auckland Speech-language Therapy Clinics: (09) 303 5979
  • the University of Canterbury Speech and Hearing Clinic: (03) 364 2408
  • the NZSTA Private Practice Directory

Approximately 9,000 people are admitted to hospitals in Aotearoa New Zealand, annually with a traumatic brain injury (TBI). 

Many more individuals suffer mild head injuries or concussions in conjunction with other injuries (e.g. spinal injuries).  Approximately 50% of those suffering a TBI are between the ages of 15 and 34.

Causes

There are several causes of TBI.  These include:

  • falls
  • road traffic accidents
  • sports injuries
  • assaults
  • playground accidents
  • workplace accidents

Characteristics

Individuals who suffer a TBI may present with a wide variety of difficulties.  These may include one or more of the following:

  • difficulties with attention, concentration, problem-solving, remembering information, verbal reasoning, and planning
  • speech difficulties ranging from speech that is unable to be understood by others (unintelligible) to mildly slurred speech
  • language difficulties such as difficulties understanding speech, difficulties expressing thoughts, finding the right word, and difficulties with reading and spelling
  • difficulties with social situations such as interpreting subtle social cues like facial expressions, gestures, and understanding humour and/or behaving appropriately in social situations
  • depression, irritability, or mood disturbances
  • difficulty eating and drinking
  • reduced or altered physical movement and sensation (e.g. balance problems, fatigue, or slow reactions)
  • altered senses of sight, smell, hearing, and taste

 All of these difficulties can affect an individual’s ability to:

  • return to work or school
  • maintain social roles and responsibilities
  • continue with previous hobbies, interests, or roles
  • drive
  • maintain independence in self-care (e.g. dressing, washing, feeding, or cooking)
  • difficulty maintaining social relationships

 In addition, these difficulties often affect an individual’s sense of identity, confidence, and self-esteem.

Role of the Speech-language Therapist

Speech-language therapists often have a significant role to play in rehabilitating individuals with a TBI.  Some of their tasks include:

  • assessment and diagnosis of any communication, speech, voice, cognitive-communication, or swallowing disorders
  • formulation of goals/treatment plans for communication, speech, voice, cognitive-communication, and/or eating/drinking with the individual, their whānau/carers and the rest of the rehabilitation team
  • advice to whānau/carers and the rest of the rehabilitation team on how to communicate effectively with the individual with a TBI
  • referrals to other organisations or groups when appropriate
  • aiming to maximise the individual’s ability to communicate effectively in all aspects of their life
  • supporting the individuals whānau to know how to be effective communication partners
  • supporting the person with TBI to return to work or school

 

What you can do

To assist someone you know who has suffered a TBI, you can:

  • find out from the speech-language therapist about their communication difficulty and the best way you can communicate with them
  • be aware of the effects impaired memory, attention and concentration, and executive functioning have on communication
  • find out from the speech-language therapist about any swallowing difficulties and any recommendations around this
  • be aware of how fatigue can affect all aspects of the person's functioning, including communication and swallowing

More Information

For more information about TBI or to contact a speech-language therapist, try contacting: