Journal CME, February 2022: Speech-language Pathology Approaches to Neurorehabilitation in Acute Care during COVID-19: Capitalizing on Neuroplasticity-Speech-language Pathology Approaches article

Speech-language Pathology Approaches article - pdf

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The article discusses the role of Speech-Language Pathologists (SLPs) in the neurorehabilitation of patients with COVID-19 in acute care settings, focusing on neuroplasticity. COVID-19 patients often display neurologic symptoms like myopathy, polyneuropathy, and stroke, which can impact swallowing, communication, and cognition, necessitating SLP intervention.<br /><br />Key points:<br />1. **Neurologic Symptoms**: COVID-19 may lead to encephalitis, encephalopathy, numbness, stroke, seizures, and altered mental status. These symptoms complicate critical care and require specific SLP approaches.<br />   <br />2. **Swallowing Deficits**: Many COVID-19 patients suffer from dysphagia, especially after intubation. Early and frequent swallowing interventions are crucial. Despite early limitations in access to instrumental assessments like VFSS, increased therapy frequency has shown potential in improving swallowing recovery.<br /><br />3. **Communication Challenges**: Prolonged intubation often necessitates tracheostomies, hindering verbal communication. Augmentative and alternative communication (AAC) methods, including electronic devices and teleconferencing, can bridge this gap. Speaking valves are suggested when medically appropriate, despite aerosolization concerns during COVID-19.<br /><br />4. **Cognitive Impairments**: Up to 70% of stroke and 40% of COVID-19 patients experience cognitive deficits, intensified by hypoxia and delirium. Early cognitive rehabilitation with patient-centered interventions and reorientation is recommended to minimize post-intensive care syndrome (PICS) impacts.<br /><br />5. **Motor Speech**: Dysarthria is common in stroke patients, necessitating specific speech interventions. The use of masks reduces speech intelligibility, making alternatives like clear masks or telehealth essential for effective therapy.<br /><br />6. **Personal Protective Equipment (PPE)**: Proper PPE (like N95 masks or PAPRs) is critical to protect both healthcare workers and patients during aerosol-generating procedures such as swallowing evaluations. Innovative solutions like telehealth can supplement face-to-face interactions when PPE resources are limited.<br /><br />Recommendations emphasize early, frequent, and tailored SLP interventions to capitalize on neuroplasticity, enhancing recovery outcomes and overall quality of life for patients.

Keywords

Speech-Language Pathologists

neurorehabilitation

COVID-19

neurologic symptoms

swallowing deficits

communication challenges

cognitive impairments

motor speech

personal protective equipment

neuroplasticity