Speech Language Pathologists in Hospitals and Other Acute and Long-Term Care Settings

Speech language pathologists are, in fact, medical professionals who are often employed in medical settings. The healthcare system is a demanding and fast-paced environment for SLPs and is not for the faint of heart. An SLP working in acute care can expect to see a wide range of patients and problems over their course of their career.

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There are a number of specialty areas within the healthcare setting where the services of speech-language pathologists are needed:

  • Acute care
  • Inpatient rehabilitation
  • Long-term care
  • Outpatient clinics
  • Pediatric hospitals

In these settings, SLPs function as critical members of patient healthcare teams, working with other medical professionals to execute care plans with every sort of patient, from premature infants to the very elderly, from sufferers of chronic diseases to victims of traumatic accidents.

Regardless of a person’s age or the state of their physical health, communication is a vital human function, making SLP therapies an important intervention to make available to patients in medical settings. SLPs also have an important role in the maintenance and function of the esophageal tract, the only natural avenue that humans have for eating and drinking in order to sustain life. Any injury or disease that disables a person’s ability to swallow or chew calls for the intervention of a speech-language pathologist to assist with diagnosis and treatment.

Speech Language Pathologist Save Lives on the Front Line in Acute Care Settings

Practice in an acute care hospital is markedly different for SLPs compared to the therapeutic nature of their work in other settings. Hospital patients come in with complex and often life-threatening medical issues that require decisive intervention on the part of a combined critical care team that includes a licensed SLP. Other members of that team will include surgeons, internists, nurses, and other specialists

The approach to patient care in a hospital requires some adaptation for SLPs who are schooled in providing longer-term interventional therapies.

SLPs working in hospitals have to be familiar with medical terminology and patient care procedures to function effectively in that environment. They are expected to serve as a specialty resource for the doctors managing patient needs in the areas of swallowing, speech, and language disorders. Those patients may be experiencing issues from a variety of causes, including:

  • Stroke
  • Head injury
  • Respiratory system issues
  • Traumatic injury

The SLP must be able to make a diagnosis rapidly and then recommend treatments based on their findings, which may range from surgery to long-term therapy. On average, patients are only under the care of acute care medical staff for 11 days. In conjunction with radiologists and other medical imaging specialists, SLPs will interpret X-rays, CT scans, and videoflouroscopic images.

According to the American Speech Language Hearing Association (ASHA), 72 percent of acute care patients who need SLP services are over 60 years of age and 35 percent are in the hospital as a result of a cerebrovascular accident – better known as stroke. Acute-care SLPs may have to perform immediate manual therapy to assist patients struggling with the ability to swallow before more definitive cerebrovascular care can be provided.

As Healing Begins, the Emphasis in the SLP Role Shifts to Long-Term Care

Once patients are out of immediate danger, the role of the SLP in the healthcare environment shifts into more traditional long-term treatment. SLPs working in rehabilitation, long-term care settings, or outpatient clinics conduct follow-up treatment with patients to help them regain their speech, language, and swallowing abilities.

SLPs in these positions have to become experts in dysphagia management. The ability for patients to swallow successfully is critical to long-term recovery prospects; studies show that five percent of stroke fatalities die of aspiration pneumonia and that one percent die of choking. Stroke patients are eight times more likely to contract pneumonia if they have aspirated into their lungs.

The primary role of the SLP as patients shift into longer term care scenarios is to minimize those risks. Surgical treatment is rare in such cases, although the SLP may recommend surgery to bypass the pharynx and oral cavity in extreme cases. Most of the time, various muscular and postural therapies are used instead. SLPs consult with dietitians to help create diets consistent with long-term nutritional health but which also consist of food stuffs that the patient can easily swallow.

Recovering speech capacity is also an important part of rehabilitation and long-term care. Although the most common causes of these problems are neurological, treatments devised by SLPs can include both strategies aimed at reducing the impairment through repetition and retraining, and to adopt alternative communication strategies that do not require complex motor functions in the vocal tract. Melodic intonation therapies, for example, take advantage of the fact that some aphasic patients have greater success singing words than saying them normally.

The Unique Challenges of Working With Infants and Children in the Healthcare Environment

The demographics of patients in long-term and rehabilitative care are similar to those in acute care hospitals, but there is a specialized niche of SLP practice working in pediatric or neonatal intensive care units (NICUs) with children and newborns. The challenges in those settings are magnified by the inability of the patients to communicate clearly, even non-verbally, or to understand instructions from the SLP.

Pediatric unit SLPs work with patients from birth to 18 years of age. The disorders in this population vary considerably from the disorders commonly found among elderly acute care patients. Pediatric and NICU SLPs face problems that stem from birth defects, disease, and trauma, including:

  • Apraxia
  • Cleft lip/palate
  • Craniofacial anomalias
  • Neurologic disease
  • Dental malocclusion
  • Autism

As with the elderly, however, dysphagia can be a common childhood problem. The process of teaching children how to cope with swallowing disorders is more complex than other patients, however. The SLP may focus more on behavioral intervention as a teaching technique, using psychological principles to mold patient eating and chewing habits. Or, they might use a variety of postural techniques to ease swallowing, including altering the position of the head and neck or positioning the entire body in a reclining position. Dietary modifications are also made to feed the patient foods that are easier to swallow.

Other common strategies employed in pediatric SLP treatment are:

  • Pacing strategies, which involve alternating the intake of food and drink
  • Oral/motor treatment to stimulate jaw and pharyngeal muscles
  • The creation of prosthetics to reform malformed jaw or palate structures

As a last resort, feeding tubes are sometimes used to inject sustenance directly into the digestive tract. It’s up to the SLP to determine whether or not this sometimes-traumatic step has to be undertaken.

A career in healthcare services provides a very different setting than the one that most SLPs find themselves working in, but it can be an excellent fit for those who are able to think on their feet and problem-solve collaboratively. There’s rarely a dull moment with frequent patient turnover and new cases every day.

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