Adult Inpatient SLP Services at Strong Memorial Hospital
Strong Memorial Hospital (SMH) is an 886-bed facility that is a part of the University of Rochester Medical Center (URMC). Strong Memorial Hospital is a teaching hospital that provides comprehensive care with multiple specialty and advanced areas of service.
Our group of Speech-Language Pathologists (SLPs) specialize in working with medically complex, critically ill patients at all levels of inpatient care. Our SLP’s are a part of the interdisciplinary medical team and provide high quality care with a patient centered approach.
Below are some of the services offered by the inpatient adult SLP care team.
Dysphagia
Dysphagia is a swallowing disorder. It can involve difficulty with the mouth, throat and/or the esophagus that changes the way food and liquids move from the mouth to the stomach. Dysphagia can occur as a result of many medical conditions including: neurological diseases-such as stroke, trauma, neck and chest surgeries, intubation and/or tracheostomy, or overall deconditioning. Dysphagia can impact what a person is able to safely eat and drink as well as how they eat and drink.
Evaluation
An evaluation for dysphagia begins with a consult from the medical team followed by a thorough chart review by the SLP. The patient is then seen by the SLP at the bedside. At the bedside, the SLP will gather more information about the swallow difficulty from the patient, nurse, and/or family. An assessment includes evaluating the movement and sensory capabilities of the mouth and face used for eating and drinking followed by observing the patient eating and drinking.
The SLP will make recommendations on if eating/drinking is safe at that time, what types of foods and liquids are safest, and strategies that will making eating and drinking easier. In some cases, further evaluation is needed to help determine these recommendations. An instrumental swallow study may be needed. There are two types of studies that can be completed, the SLP will determine which one would be the most appropriate to further evaluate swallow function. These studies include:
Modified Barium Swallow Study (MBSS)/ Video Fluoroscopic Swallow Study (VFSS)
An MBSS is a study that uses x-ray to assess your ability to swallow food, liquids, and pills. The study is completed in radiology with the speech-language pathologist, radiology technologist, and radiologist or radiology physician assistant.
Flexible Endoscopic Evaluation of Swallowing (FEES)
A FEES is a study using an endoscope (flexible tube with a camera) that is passed through the nose and into the throat to view the area directly while the patient eats and drinks. This study is performed in the patient’s room.
Treatment
In some cases, ongoing SLP services may be needed to:
- Advance diet and liquid levels as overall medical condition improves
- Work on exercises to improve impaired areas of the swallow
- Teach strategies that make eating and drinking more safe or easier
- Consults to other specialty doctors may be recommended for further evaluation.
After the Hospital
Ongoing SLP services may still be needed when the patient leaves the hospital. The Speech-Language Pathologist will work with the medical team to help to make appropriate recommendations. Ongoing therapy may be needed at a skilled nursing facility, rehab center, through outpatient care, or homecare.
Aphasia
Aphasia is a language disorder that impacts a person’s ability to communicate. Aphasia is typically caused by stroke, brain injury, brain tumors or it’s treatment. Aphasia can cause difficulty with
- Speaking – coming up with the words to say, saying the right word, or saying the word correctly
- Understanding what others are saying
- Reading
- Writing
- Using gestures
Evaluation and Treatment
An evaluation for aphasia begins with a consult from the medical team followed by a thorough chart review. The SLP will perform a specialized evaluation targeting the areas listed above.From this evaluation, the SLP will help to identify areas of communication strength and weakness.While in the hospital, the SLP can help guide the patient, staff, and family on strategies to improve communication and provide education.
After the Hospital
Ongoing SLP services may still be needed when the patient leaves the hospital. The Speech-Language Pathologist will work with the medical team to help make recommendations.Ongoing therapy may be needed at a skilled nursing facility, rehab center, through outpatient care, or homecare.
Motor Speech Disorders (Dysarthria and Apraxia)
Dysarthria is a speech disorder that can impact the muscles of the face, lips, tongue, throat, as well as muscles used for breathing. Dysarthria can be a symptom of multiple diagnoses including: stroke, brain injury, trauma, tumors & their treatments, or other neurological disorders.
Dysarthria can result in speech sounding different. If can make talking sound:
- Slurred
- Slower in rate
- Softer in volume
- Choppy or without normal pausing
Apraxia is a motor disorder that can make it difficult for the brain to communicate with muscles to perform certain movements. Apraxia can affect different muscle groups such as in the arms, legs, or even those used to speak. Apraxia can be acquired as a result of stroke, brain injury, brain tumor or it’s treatment.
Evaluation and Treatment
An evaluation for dysarthria or apraxia begins with a consult from the medical team followed by a thorough chart review. The SLP will perform a specialized evaluation targeting speech and language as these areas can present similarly.From this evaluation, the SLP will help to identify areas of communication strength and weakness.While in the hospital, the SLP can help guide the patient, staff, and family on strategies to improve communication and provide education.
After the Hospital
Ongoing SLP services may still be needed when the patient leaves the hospital. The Speech-Language Pathologist will work with the medical team to help make recommendations.Ongoing therapy may be needed at a skilled nursing facility, rehab center, through outpatient care, or homecare.
Cognitive Communication Disorder
A cognitive communication disorder can affect multiple areas of cognition used for communication and activities of daily living. They can be the result of: stoke, brain injury, brain tumors & their treatments, and other neurological disorders. Areas of impairment can include:
- Alertness
- Orientation
- Attention
- Memory
- Reasoning
- Insight
- Problem solving
- Planning
- Organization
- Social behavior
Evaluation and Treatment
An evaluation for cognitive communication begins with a consult from the medical team followed by a thorough chart review. The SLP will perform a specialized evaluation targeting the cognitive areas described above. From this evaluation, the SLP will help to identify areas of strength and weakness. While in the hospital, the SLP can help guide the patient, staff, and family on strategies to improve cognitive communication and provide education.
After the Hospital
Ongoing SLP services may still be needed when the patient leaves the hospital. The Speech-Language Pathologist will work with the medical team to help to make recommendations. Ongoing therapy may be needed at a skilled nursing facility, rehab center, through outpatient care, or homecare.
Speaking Valves (Tracheostomy and Ventilator Communication)
A speaking valve allows patients with tracheostomies to use their voice. It also helps to improve the ability to cough, manage secretions, and aid in swallow function. A speaking valve is a small attachment that is placed at the opening of a tracheostomy tube. This one-way valve allows the patient to breath in through the tracheostomy tube but does not allow breathing out. The speaking valve re-directs air upward around the trach to vibrate the vocal fold (voice box) to make voice. The speaking valve is often used as a step in the path to removing the tracheostomy tube.
Evaluation and Treatment
An evaluation for a speaking valve begins with a consult from the medical team followed by a thorough chart review. The SLP will trial the speaking valve with the patient to determine candidacy for on-going use.
After the Hospital
Many patient’s have their tracheostomy tubes removed prior to leaving the hospital. If the patient still has a tracheostomy tube at discharged the medical team will help coordinate ongoing care of the tube and speaking valve at the next level of care.
Augmentative and alternative communication (AAC)
Augmentative and alternative communication (AAC) options may be appropriate when a patient’s ability to communicate verbally is not possible. This can be due to intubation, ventilator dependence, trauma, progressive neuromuscular disease or severe speech impairments. Use of AAC may be temporary or permanent. Alternative forms of communication may include:
- Writing
- Texting/typing
- Gesturing
- Communication boards
- Alphabet boards
- Speech-generating devices (SGD’s)
Evaluation and Treatment
An evaluation for augmentative and alternative communication begins with a consult from the medical team followed by a thorough chart review. The SLP will perform a specialized evaluation including:
- A comprehensive evaluation of speech, language, and cognition
- Screen of vision, hearing, and motor skills
- Trials of different types of AAC that are most appropriate
Once an appropriate form of communication has been determined, the SLP will work with the patient, staff, and family to train and maximize its use to allow the patient, medical team, and family to optimize communication.
After the Hospital
If at the time of discharge the need for alternative and augmentative communication is ongoing, the SLP will work with the medical team to help to make recommendations. Ongoing therapy may be needed at a skilled nursing facility, rehab center, through outpatient care, or homecare.
Voice and upper airway disorders
Voice and upper airway disorders can affect the way the voice sounds, it’s volume, as well as breath support needed to make voice. Voice and upper airway disorders can occur after prolonged intubation, neurologic infarcts/injuries, and surgeries involving the neck and chest.
Evaluation and Treatment
An evaluation for voice and upper airway begins with a consult from the medical team followed by a thorough chart review. The SLP will perform a specialized evaluation that may include:
- Referral and collaboration with otolaryngology (ENT) team
- Informal assessment of voice and breathing function
- Stimulability trials for response to intervention techniques
- Education of voice and breathing anatomy & physiology
After the Hospital
Ongoing Speech-Language Pathology and otolaryngology (ENT) services may still be needed when the patient leaves the hospital. The Speech-Language Pathologist will work with your medical team to help to make recommendations for ongoing intervention.