Speech Pathology in the Hospital Setting

I have worked in the field of Speech Pathology for 18 years now, and I wanted to provide you with some insight to what occurs when an endotrachael tube is removed from a patient in the intensive care (ICU) setting following a sudden onset of TBI (traumatic brain injury).

The patient is first assessed for vocal production. That is, we check to see if the patient is able to physically move their vocal cords. In some instances, there can be swelling in and around the area of the vocal cords secondary to trauma and the actual placement of the tube itself.

Secondly, depending on the part of the brain that is affected, we would then assess if there are deficits to the motor programming that controls one or both vocal cords. If there is a unilateral paresis or paralysis of one vocal cord, the voice could be very soft or breathy in nature.

Then we would assess the speech and language abilities of the patient. We would assess if the patient has a dysarthria in the face, tongue, lips or jaw that would impact articulation. We would also assess if the patient exhibits apraxia, a motor programming component to speech. A classic sign of apraxia is “groping” when attempting to communicate.

Next, language would be assessed. Language is divided into receptive (listening/reading) and expressive (speaking/writing) abilities.   The left hemisphere of the brain controls language in most right handed individuals.   A complete Aphasia Diagnostic Battery, such as the Boston Test of Aphasia or the Western Aphasia Battery would be implemented. One or both of these diagnostic batteries would give the clinician very specific data as to what breakdowns have occurred in expressive and receptive modalities.

Lastly, we need to evaluate swallowing. Most patients can exhibit signs and symptoms of dysphagia (a swallowing disorder) after sudden onset of TBI. Since most patients are unresponsive secondary to trauma, most have a nasogastric (NG) tube or a percutaneous endoscopic gastrostomy (PEG) tube placed for nutrition purposes. A Speech Pathologist, in conjunction with a radiologist will complete a modified barium swallowing assessment (MBSS) in the hospital to assess and determine the safest, least restrictive diet that a patient can safely tolerate. It is not uncommon for a patient to be non per oral (NPO) for weeks or months until the patient is alert enough to tolerate safe deglutition (swallowing). Types of dysphagia diets can include pureed, mechanical soft, chopped and regular foods. Liquids can be thin, nectar thick, honey thick or pudding thick consistencies.

Speech pathologist play a vital role in assisting patients recover voice, speech, language and swallow function, both on an inpatient and outpatient setting. I have provided evaluations and treatment in both settings for over 18 years now, and if you have any questions regarding speech therapy services in Tucson, please contact me here.