05th FEB 2021

What is the role of Speech Language Pathologist in stroke rehabilitation?

Speech-language pathologists (SLP) play a significant role in the screening, formal assessment, management, and rehabilitation of stroke survivors who present with dysphagia and/or communication and cognitive impairment.

The first part of the evaluation involves diagnosis for consciousness involvement particularly with regard to

Presence of Coma and other states of impaired consciousness (vegetative state, minimally consciousness state)

Almost 70 percent of stroke survivors are likely to experience a disorder of consciousness. The part of the evaluation carried out by the SLP is to examine the cognitive performance (wakefulness), verbal and motor responsiveness and orientation of the patient to the person, position and time. During the post-stroke stage, The SLP will come up with:

A multimodal sensory stimulation program which requires that two or more sensory domains to be simultaneously stimulated, in any preferred combination. The sensory domains includes Visual Stimulation, Auditory Stimulation, Tactile Stimulation, Olfactory Stimulation, Gustatory Stimulation, Vestibular Stimulation Kinesthetic Stimulation and Proprioceptive Stimulation.

The second part of the evaluation involves diagnosis for swallowing involvement particularly with regard to

Presence of Dysphagia (difficulty in swallowing)

Presence of Drooling of saliva

Presence of Difficulty in chewing

Presence of food residues inside the mouth

Presence of Abnormal volitional cough, abnormal gag reflex, cough after swallow, and voice change after swallowing

Up to 50% of acute stroke patients are likely to experience dysphagia. If it is not recognized early, dysphagia may be responsible for aspiration, aspiration pneumonia, and/or under nutrition and dehydration. Stroke patients with

dysphagia are likely to have poorer outcomes. Therefore, dysphagia screening should be undertaken as soon as possible after the patient has been admitted to hospital and before starting oral intake of food, fluids, or medication. After complete comprehensive assessment, the SLP will come up

Head Positioning for oral intake and oro motor sensory stimulation

A sensory stimulation program to encourage swallowing activity if no level of oral intake appears 'safe'

Using certain swallowing maneuvers such as supraglottic swallow, super supraglottic swallows, Mendelssohn’s maneuver etc.

Oromotor exercises for proper chewing and to reduce drooling

Texture ,taste and temperature modifications and specification for all oral intakes

Feeding objects modifications and specifications for all oral inatkes

Recommendations for oral medications

Requirements for meal-time monitoring, including indicators of poor swallow functions.

The third part of evaluation involves diagnosis for communication involvement particularly with regard to

Presence of dysarthria and dysphonia (inability to utter sounds in a proper manner)

Presence of Aphasia (inability to understand the instructions and express their needs either verbally or non verbally)

Presence of Apraxia (inability to perform simple motor tasks in response to commands)

However almost 70% of stroke survivors are likely to develop Dysarthria, made possible by potential respiratory, phonatory, resonance, and/or articulatory system impairments. The SLP will come up with

Exercises to improve the respiratory/phonatory parameters underpinning speech may include non-speech, postural, and speech activities

Resistance training techniques which can target respiratory and/or phonatory muscles directly when reduced strength is hypothesized

Among stroke survivors, 30-60% is likely to experience a communication deficit. Communication deficits have been demonstrated to be associated with depression and therefore, by inference, with quality of life. The part of the communication assessment undertaken by the SLP is to examine the communication environment which impacts on the stroke survivor. During the post-stroke stage, The SLP will come up with:

What communication devices, if any, can support the stroke survivor in their efforts to communicate

What communication strategies can be employed by communication partners to enhance communication with the stroke survivor

What education is required by communication partners (including family, significant others, and staff) to employ the identified strategies

What support the stroke survivor requires to access written information relevant to their care

What support the stroke survivor requires to access leisure time activities in their own environment.

Stroke survivors who demonstrate impairment in the areas of attention and memory will frequently have concomitant communication involvement. The SLP will also work to minimize the impact of these cognitive impairments on communication. In particular, areas such as verbal attention, divided attention, sustained attention, auditory memory, verbal memory, visual neglect and executive functions which have a direct impact on communication. The SLP will come up with

What attention strategies and memory strategies, if any, can be employed by communication partners to enhance effective communication with the stroke survivors.

Rehabilitation plays a significant role in helping people get integrated into an active community. Check with your nearest pulmonary rehabilitation clinic for a thorough examination, today.