I split my time working in the rehabilitation unit at Louth County Hospital and in Our Lady of Lourdes Hospital, in the acute stroke ward.
At Our Lady of Lourdes Hospital, where I work with acute stroke patients, I start my day checking with the nursing staff as to how the patients are, what medical assessments they have and I organise my day around their schedules.
When a person comes in after having an acute stroke in the last number of hours, the medical team contacts me to get a swallow assessment carried out to see if it is safe for the person to take medications and to see if they can eat and drink.
It is usually in the immediate admission period that someone like me gets involved.
After having a stroke a person might not have the ability to chew food anymore because the muscles of their mouth and tongue are weakened, and food can go down the wrong way into their lungs and give them a chest infection.
A swallowing difficulty is called dysphagia.
If I feel it is unsafe for the person to eat or drink – due to the risk of inhaling food or fluid into their airways or of choking – I will contact the medical team and advise them of this. Usually the team will then contact the dietetics department and they will discuss whether the person would be suitable for something such as a NG (nasogastric) tube. It is a tube going from their nose into their stomach and can be a short-term solution for nutrition.
Sometimes patients can have a modified diet or modified fluid.
When I do the swallow assessment, I am also checking the person’s language ability. I will listen to see if they are having any problems with the understanding of language and then I will see how they are getting on with their ability to speak and to generate sentences.
That would usually happen all in one session at an informal level.
If someone has a problem with language after a stroke, the medical name is aphasia. They will have different strengths and weaknesses.
Often people might be able to understand a lot of what you are saying, but not be able to give you a message back.
Speech difficulties
I also work with motor speech difficulties, working with people who have problems with slurring of speech.
Once I have an idea where the person’s difficulty is, I develop a programme. In that acute phase I do a lot of education as well – speaking with the patient, if they are able to understand, and with their families.
For the person who has had a stroke, it’s a sudden onset of a disability.
It’s completely unexpected and it’s an emotional journey.
Often I might have a programme ready to present to a person but they come into me and start crying their eyes out. So I abandon what I was going to do and give them the support they need. Often with families it can be very much the same – giving support.
The stroke can result in a complete change in role for a person. You might have someone who is usually the person in a relationship or family who organises the bills, writes the shopping list, does the shopping, and so on. Now they have difficulty reading and writing so they can’t read the packages on the shelves and they cannot write the list. Sometimes they feel their identity is gone.
So, a huge part of my role is supporting people to cope with these changes.
In Louth County Hospital, we have an eight-bed rehabilitation unit for people who have had a stroke. In Drogheda we meet as a team to see how people are progressing and to see who may be suitable for rehab. The team in Dundalk look at the referrals and we accept who we feel is appropriate.
There is quite a good seamless service between the two hospitals and I’m really lucky because I often meet people in the emergency department and then get to see them go home, which is lovely.
In the rehabilitation facility, it’s more of a focus on having your daily speech and language therapy, occupational therapy and physiotherapy.
I do a lot of work with the occupational therapist, usually around functional things such as being able to get your shopping list ready to go to the shop to buy a few bits and pieces.
Patients would stay in the unit usually for about six to eight weeks, but that can change depending on whether the person is making progress and what goals we have.
Rehab unit
Being in the rehab unit in Dundalk gives me an opportunity to spend more time with the patient, but also to speak to the speech therapist who we have in the community about the needs the patient will have when they are discharged home.
As well as assisting people to say what they want and to understand what they hear, speech and language therapy involves helping people to read and write.
When I say writing I really mean spelling, not the physical holding of the pen – that is occupational therapy.
Sometimes people might be able to have a conversation with one person for a short period of time and then their brain can get tired. If another person comes into the conversation, they might have difficulty just keeping up with that. So it is about trying to improve their stamina as time goes on.
What’s excellent about the rehab setting in Dundalk is that we get people ready to go home. When they are in rehab, patients are protected and there can be a huge sense of fear and anxiety about going home.
We have asked people who previously were in rehab to come in and talk to our patients about going home and their experiences. That can often settle the nerves.
Patients also told us they would love something like that in the community, where they could go and talk to other people who have experienced stroke.
The Irish Heart Foundation has helped us set up two stroke support groups in the past year, one in Dundalk and one in Drogheda.
Patients can go to them on a weekly basis when they have been discharged home.
The most rewarding aspect of the job is seeing someone improve. It can be very emotional. People can be so upset and say how they wished the problem was with their leg and not with their speech. But at the end you can tell them, “You are going home, you are going to get your life back.”
The most challenging cases are the bad outcomes when someone has had a really severe stroke and, despite a lot of intervention, they might still not be able to either communicate or swallow.
It is very difficult having to tell someone that maybe it is safest not to eat or drink anything for the rest of their life. Out of hours I go swimming every morning before I go to work. I've only started that in the last year, but that's definitely given me a bit of zen.
Sometimes I find it hard to switch off if I'm honest. I have come home at night and cried over sessions that I've had. I try to meet up with friends and family and I crochet, which sounds very grannyish, but I do.
