Initial enquiries regarding instructions can vary from a quick "can you confirm your email" to a detailed letter outlining the case and skills and expectations of the expert. I always ask myself I am the right person and do I have the necessary skills and experience to provide an expert opinion on this case? Remember your professional credentials may be challenged in court so only take on cases you have the expertise to fulfil.
Sometimes a bundle of papers can arrive without warning. The bundle can be as little as one or two pages to what seems like endless lever arch files. I have become more adept at screening quickly to establish what is relevant to speech and language therapy so as not to spend hours reading unrelated materials.
Some of the claimants have a treating speech and language therapist, some have had no speech and language therapy to date and some have not had any for many years. There may be a case manager involved. I may speak to the treating therapist or case manager to gain further information, if agreed by the solicitor instructing me.
The form the assessment takes is dependent upon the clients needs and any background information revealed from the bundle. For example what their interests are, who they live with, football team, etc. this information can be used to establish rapport at the outset of the medico-legal assessment. It is also a means of observing their communication skills in amore functional context.
Formal language assessment is an important part of the appraisal as this can give an indication of their functioning compared to people of the same age, education level and gender as well as measuring progress which is particularly important if producing a follow up report. I will record the assessment, on occasion, particularly if someone has a complex speech and language presentation or if their speech needs more detailed analysis or transcription.
Many of the people I see have swallowing difficulties (this can be in addition to their communication difficulties). I will undertake a detailed assessment looking at
- oromotor skills (which muscles and nerves are affected)
- risk of aspiration (food or fluid going down past the level of the vocal cords)
- speed and efficiency of swallow
- impact of posture and positioning
- size of bolus
- method of presentation
- feeding vs self-feeding
I also think that when writing a speech and language therapy medico-legal report that is important to establish their wish for further therapy, either now or in the future. What are their goals? What do significant others e.g. partner/parents/employer want?
Once formal and informal assessment, exploration of impairment, disability and quality of life issues have been explored and any other relevant factors considered the assessment with the person concludes.
Contact me today to discuss your speech and language therapy medico-legal reporting needs.