For anyone who has suffered a stroke, head injury, or other medical condition that has affected the vocal and pharyngeal tracts, the path to recovery is long and difficult. According to the American Stroke Association, complete recovery from a stroke can take up to two years. Without professional assistance, learning to speak or eat properly again might simply be out of reach for many patients.
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Fortunately, speech language pathologists (SLPs) who specialize in providing rehabilitative services are there to help them along that road.
Rehabilitation is the step in the treatment process that comes after the acute care rendered immediately after an incident or accident. Rehab may begin in a hospital setting and transition into outpatient, home healthcare, or long-term care facilities, depending on the patient’s capabilities and prognosis.
Rehab SLPs work with a larger team of professionals including:
- Physicians
- Nurses
- Physical Therapists
- Occupational Therapists
- Audiologists
They are responsible for keeping other members of the team briefed on patient progress and prospects, usually at daily meetings held for that purpose. They also keep charts updated with the most current information on their treatment plan and therapies so that all staff are on the same page. Strong documentation skills are a must, both for communication and billing purposes.
Together with other staff members, SLPs will do intake assessments on new patients coming under their care. This will involve reviewing medical charts and notes from providers in the acute care setting where the patient is coming from as well as performing their own diagnostic tests on the individual.
The satisfaction that comes from seeing a patient come under care in the most dire straights and then emerge with full speech and swallowing function after months of intensive rehabilitation may make this role one of the most rewarding in the speech language pathology career field.
Taking Trauma and Stroke Survivors and Making Them Whole Again
Rehab SLPs can be found working in:
- Hospitals
- Clinics
- Nursing homes
- Patient homes
The patient population SLPs work with in rehabilitation facilities of all types closely resembles the population found in acute care settings, where the majority of patients are elderly: 70% of the patients in inpatient rehabilitation are over 60 years of age.
And, like acute care speech pathology patients, fully half of those in rehabilitation are being treated after suffering a cerebrovascular accident (CVA), otherwise known as stroke.
SLPs are critical to the survival and meaningful recovery of stroke patients. The average stroke patient who survives the initial event has a 75% chance of living for at least another year. But, particularly with older and more severely afflicted victims, swallowing difficulties can lead to long-term problems; one percent of survivors die from choking and another five percent from aspiration pneumonia.
Both issues can be caught and corrected with an attentive SLP on the case. SLP-mediated dysphagia treatment has been shown to reduce mortality rates by 10%.
Speech-difficulties are the other major issue that stroke survivors face, and SLPs have a role to play in helping these patients recover the ability to communicate clearly. Thirty to sixty percent of stroke survivors experience a communication deficit. Strategies for treatment include:
- Word retrieval retraining
- Role-playing communication for practice
- Rebuilding vocabulary
- Exploring alternative non-verbal communication techniques
Stroke is only the most-common reason patients enter rehabilitation, however. Victims of chronic disease, traumatic accidents affecting the mouth and throat, and patients with other neurological deficits all may end up in rehabilitation at some point.
SLPs are also gradually finding themselves being called on to help treat victims in fields they have not traditionally been involved in, such as burn care. Essentially, any sort of damage or disease that requires long-term care to re-learn proper speaking and swallowing techniques might call for the participation of a speech language pathologist at some point.
Rehab SLPs Serve as Supervisors, Therapists and Personal Coaches
While SLPs in most settings work with patients one-on-one, rehab SLPs often provide therapy services in group settings. A single SLP in a rehab unit might be responsible for around 20 patients at any given time. While they will provide individual treatment as appropriate, many of those patients will likely be receiving the same types of instruction and therapy, making it a good use of time to practice in a group setting.
As simple as it sounds, as part of an effective therapy regimen SLPs in rehabilitation settings often go to lunch with their patients. The SLP isn’t there to eat, though; instead, they are there to observe the patient eating and look for any swallowing difficulties the patient is having so as to better understand the best course of action. The SLP might intervene and coach the patient during the meal to undertake such practical steps as turning or inclining their head in a particular direction, or they might simply make notes about foodstuffs that would be easier for the patient to consume. Those notes would then go to a dietician for review and input before making it into the patient’s meal plan.
In rehabilitation settings, SLPs might supervise a team of speech therapy assistants. The assistants are responsible for implementing therapy plans created by the SLP, and the SLP is responsible for ensuring those plans are being executed properly.
Because rehabilitation is a long and continuing process, SLPs also lay the groundwork for self-treatment and home-based therapies for patients. According to the American Speech Language Hearing Association (ASHA), the average stay for a patient in in-patient rehabilitation is only 20 days. Full recovery, if it is even possible, can take anywhere from several months to years. So SLPs not only work with patients on their immediate steps to recovery, but also brief their family members and train them on techniques to use to continue rehabilitation at home.
After the patient is discharged, rehab SLPs will continue to work with them on an intermittent basis, assessing progress and adjusting the treatment plan as necessary in an outpatient setting. Only when the patient has achieved their goals does the speech language pathologist finally step out of the picture.