Coronavirus: Speech Language Pathologists Playing Key Frontline Role

Coronavirus patients who are placed on ventilators need help from speech language pathologists such as restoring the ability to swallow.

Speech language pathologists are providing essential rehabilitation services to patients recovering from serious cases of coronavirus disease 2019 (COVID-19).

Many seriously ill COVID-19 patients are placed on ventilators due to acute respiratory distress syndrome. Speech language pathologists provide rehabilitation services for damage caused by mechanical ventilation, which includes injury to vocal cords from breathing tubes and deconditioning of the muscles needed for swallowing.

"Those patients who end up in the ICU either have a tracheostomy, or they have a tube that is pushed down through their vocal cords to have an airway to help them breathe. Then they are placed on a ventilator to help save their lives. They are on a machine that is helping them breathe, potentially for weeks. They are bedridden and they have a tube down their throat, so they lose their ability to eat and swallow," says Rinki Desai, MS, a speech language pathologist and adult outpatient lead at the University of Mississippi Medical Center's Voice and Swallowing Center in Jackson, Mississippi.

Rehabilitating patients' ability to swallow is a primary service provided by speech language pathologists, she says. "About 90% of what we do in the field of medical speech language pathology is treating swallowing disorders. For example, patients who experience a stroke can have trouble with swallowing, breathing, speech-language communication, and cognition. So, on a given day in a hospital ward or ICU, that is the kind of care that we provide."

COVID-19 patients who are placed on a ventilators need speech language pathologists to regain key functions, Desai says.

"These patients are not swallowing. They are not able to communicate verbally, and they have a significant impact on their voice. If a patient goes anywhere beyond two days on a ventilator, there can be significant injuries. For COVID-19 patients, the most immediate impairment that speech language pathologists treat in the ICU is helping patients communicate while they are on a ventilator using a white board or gestures. Once patients are off the ventilator, we help them breathe, swallow, and use their voice again."

There are three main categories of rehabilitation services that speech language pathologists provide to COVID-19 patients who require mechanical ventilation, she says.

1. Swallowing: "We start patients with swallowing ice chips, then gradually get them to the point where they can eat by mouth. We make sure they are safe, with efficient swallowing. We also help with respiratory-swallowing coordination."

2. Communication: "If patients have trouble communicating, we will provide specific therapies to get their communication back. Typically, they lose their voice because of the damage to their vocal cords. In those cases, we have very specific voice therapy techniques and exercises to help patients get their voice back as soon as possible."

3. Cognition: "If patients have trouble with memory, orientation, loss of consciousness, or delirium, our goal is to help patients regain function. We help them process and follow commands. We help them to get back to being as independent as possible with activities of daily living before they leave the hospital."

Pandemic challenge

In the early phase of the coronavirus pandemic, shortages of personal protective equipment (PPE) posed a significant challenge for speech language pathologists and their seriously ill COVID-19 patients, Desai says.

"We did not have enough personal protective equipment, so we had to limit the number of people going into patient rooms. We had to make a decision—who are the most essential people who need to go into the patient rooms? It was the pulmonologists, the ICU physicians, and the ICU nurses. So, we were dealing with rehab professionals not being able to see patients quite a bit—sometimes until they were COVID-19 negative."

Delaying the rehabilitation services that speech language pathologists provide to COVID-19 patients increased length of stay in ICUs, she says. "For every day a patient is in an ICU, the patient is bedridden and deconditioning, and it takes about a week to recover function."

Fortunately, University of Mississippi Medical Center was able to secure adequate supplies of PPE, Desai says.

"Now that we have enough PPE—we have our N95 masks, face shields, and other equipment—speech language pathologists are going in right away even if the patient has tested positive for COVID-19. We start therapy as soon as we can because we want to minimize deconditioning and weakness. We want patients to start eating and using their voice muscles as soon as possible."