Quality standard

Quality statement 5: Communication

Quality statement

Adults with cerebral palsy who have communication difficulties have their need for intervention assessed by speech and language therapy services.

Rationale

People need to be able to communicate to fully engage in decision making and participate in social, family and economic activities. Adults with cerebral palsy can have communication difficulties caused by their underlying motor disorder, learning difficulties or problems with equipment. Referral to speech and language therapy services enables people with cerebral palsy to have their communication difficulties assessed and to be offered suitable interventions. Interventions may include intensive speech therapy, to improve the intelligibility of their speech, and alternative and augmentative communication (AAC) systems. When AAC systems are provided, people with cerebral palsy, their families, carers and other key communication partners are given training to ensure they are used effectively.

Quality measures

Structure

a) Evidence of processes to identify adults with cerebral palsy who have communication difficulties.

Data source: Local data collection, for example, from service specifications or directories of services.

b) Evidence of local referral pathways to speech and language therapy services for adults with cerebral palsy who have communication difficulties.

Data source: Local data collection, for example, from service specifications.

Process

a) Proportion of adults with cerebral palsy who have communication difficulties referred to speech and language therapy services to have their need for intervention assessed.

Numerator – the number in the denominator referred to a speech and language therapy service to have their need for intervention assessed.

Denominator – the number of adults with cerebral palsy who have communication difficulties.

Data source: Local data collection, for example, local audit of patient records.

b) Proportion of adults with cerebral palsy who have communication difficulties referred to speech and language therapy services who have their need for intervention assessed.

Numerator – the number in the denominator who have their need for intervention assessed.

Denominator – the number of adults with cerebral palsy who have communication difficulties referred to speech and language therapy services.

Data source: Local data collection, for example, local audit of patient records.

Outcome

Change in therapy outcome measures (TOMs)[1] following intervention.

Data source: Local data collection, for example, local audit of patient records. The Royal College of Speech and Language Therapists Online Outcome Tool supports speech and language therapists with collecting and collating TOMs data and generating reports.

What the quality statement means for different audiences

Service providers (speech and language therapy services) ensure that referral pathways are in place so that adults with cerebral palsy and communication difficulties can be assessed by speech and language services. They have systems in place to undertake assessments, provide intensive speech therapy and access to AAC systems. They provide training on AAC systems for adults with cerebral palsy, their families, carers and other key communication partners in home, care, social or work environments.

Healthcare professionals (such as GPs, rehabilitation consultants and neurology consultants) ask adults with cerebral palsy about any changes in, or problems with, their hearing, speech and communication at every clinical review. They refer people who have communication difficulties to speech and language therapy services. Speech and language therapists assess their need for intervention, which may include use of intensive speech therapy to improve the intelligibility of speech and AAC systems.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they develop pathways that allow adults with cerebral palsy who have communication difficulties to be referred to speech and language therapy services for assessment and intervention. They also commission intensive speech therapy and specialised or local AAC services.

Adults with cerebral palsy are asked if they have problems with their hearing, speech and communication when they are reviewed by a healthcare professional. If they are having problems, they are referred to a speech and language therapist who will check for any problems and discuss ways in which their communication can be improved.

Source guidance

Cerebral palsy in adults (2019) NICE guideline NG119, recommendation 1.2.6

Definitions of terms used in this quality statement

Adults

For this quality standard, adults are defined as people aged 25 and over, in line with the source guidance. The NICE quality standard for cerebral palsy in children and young people covers people under 25.

[NICE's guideline on cerebral palsy in adults]

Alternative and augmentative communication (AAC) systems

A variety of methods (for example, signing, use of visual symbols and eye gaze technology) that can be used to help people with disabilities communicate with others. These systems or methods of communication can be used as an alternative to speech or to supplement it.

[NICE's guideline on cerebral palsy in adults, terms used in this guideline]

Communication difficulties

A range of problems that an adult may have with expression and understanding. This includes problems with speech and non-verbal forms of expression, understanding what is being said to them, understanding emotions, using words and grammar and speaking fluently.

[NICE's guideline on cerebral palsy in adults, supplement B: glossary and abbreviations]



[1] TOMs are measures that describe the abilities of a person in 4 dimensions: impairment – the severity of the difficulty or condition; activity – the impact on the person's independence; participation – the impact on social engagement and autonomy; wellbeing – the impact on mental and emotional wellbeing.