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And the Winner of the LBU Chris Wade Award for Clinical Innovation 2018 is....

Gillian McCormick - 1st Place!

The aim of the project was to support the procedure of an awake craniotomy for both the service and for the client. An awake craniotomy is a surgical procedure to remove a brain tumour while preserving the patients’ speech and movement (eloquent areas) through assessment during the resection. The operation can extend life and offer a quality of life.

The speech and language team provide pre-operative, intraoperative and post-operative assessment to support the preservation of the eloquent areas of the brain for language and speech. Above and beyond that, the speech therapist also offers support and counselling throughout the whole process. They explain the procedure and answer any question relating to it and support the family. The process begins at 7am in the morning and can finish at 7pm the day of the surgery. There is a lot consider, and remember, so I wanted the project to support the whole process and be of benefit to the service.

Outcome of the Project and Resources

The outcome of the project was to produce a two-sided laminated information sheet to share with neurosurgical colleagues in the planning of intraoperative testing of speech and language. This information was to be taken from the following reference:

De Witte, E. Satoer, D. Robert, E. Colle, H. Verheyen, S. Visch-Brink, E. Mariën, P. (2015) The Dutch Linguistic Intraoperative Protocol: A valid linguistic approach to awake surgery, 140, pp. 35-48.

The article is a normative study of 250 native Dutch speaking healthy adults assessed to develop a standardised Dutch linguistic test battery measuring phonology, semantics and syntax. The battery is to standardise neuro- linguistic methods when operating on the brain and electrically stimulating eloquent areas. The clinical application of the battery on anatomo-functional models are discussed in five case studies where the assessments were based on the location and degree of linguistic impairment. The article discusses the validity of the battery and the intraoperative mapping of eloquent language regions that are variably located.

The project will be an accessible document to show the regions of the brain, the function, the intraoperative language tasks and the assessments that can be used. This can then be used as a reference for the multi-disciplinary team in the operating theater and will be readily accessible information for the speech and language therapist.

Outcome of Project

The outcome was a two-sided document that shows colour-coded pictures of the cortical and sub-cortical areas of the brain and the regions listed in a table below. The table lists the function of the brain region, language tasks and assessments to be used. The information was to be visual and easy to use.

An additional outcome was that it shows that a small number of tasks can assess phonology, semantics and syntax which is beneficial to the SLT and the client. Also, that the procedure that the team have been using has been in line with this valid battery of assessments.

Educator feedback

The project was worked on collaboratively to ensure it would be of use to the speech and language team, and the neuro-surgical team. My educator confirmed that it was something she would share with her neuro-surgical colleagues in the planning of intraoperative testing.

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London Speech Therapy
127 Harley Street
London, UK