COVID-19 (coronavirus) Featured Rehab

The role of speech language pathology in COVID-19 recovery

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Written by Lindsay Smith

Pictured: Zubeen Dharshi, speech-language pathologist

People may not associate speech-language pathologists with COVID-19 recovery, but these health care professionals have a critical role with COVID patients, from the ICU to acute care to rehab, and three of Sunnybrook’s speech-language pathologists shared how they support COVID patient recovery and why their role is so important.

Speech and swallow therapists

Nabil Jabbour is a speech-language pathologist at Sunnybrook who works with ICU patients and he says he and his colleagues are really “speech and swallow therapists,” so when COVID-19 patients who have been on ventilators for a prolonged period of time, or on high-flow oxygen experience dysphagia, or difficulty swallowing, it’s speech-language pathologists who provide assessment and treatment to help these patients transition from tube feeding to eating and drinking by mouth.

“These patients have had no airflow through the throat for a long time and have not used their muscle to swallow, so their muscle … becomes weak,” says Nabil. “Not only that, but the vocal cords get weak, the voice is hoarse, there is swelling in the throat, reduced sensation, etc.”

It can take a lot of time and therapy for patients to regain the ability to swallow, especially if there are other health conditions present.

“The recovery is hard,” says Zubeen Dharshi, a speech-language pathologist who works in acute and transitional care at Sunnybrook’s Bayview and Holland Centre campuses. She says COVID patients are more complex, and if there is an underlying condition such as MS or Parkinsons, “their deficits, such as muscle weakness or incoordination, get amplified even more.”

Communication skills post-COVID

At St. John’s Rehab, speech-language pathologist Stephanie Durocher-LeBlanc works with patients who are well enough to have been discharged from the hospital, but could still use support in their recovery. Sometimes she’ll continue swallowing therapy, but Stephanie also sees patients who are having trouble recovering their communication skills after being ill with COVID-19.

“They’re foggy, they have delirium, they’re just not as quick, not as sharp,” she says. And since the onset of the pandemic, the demographic of her patients has trended younger, in the 30-50 age range, which means these are people who need to return to full and busy lives.

“It’s not enough that they can functionally get by,” Stephanie says. “They have to run their kids’ lives over Zoom and do their own job; it’s not good enough to be foggy all day.”

She helps patients with their “cognitive communication” by practicing everyday tasks such as setting up a schedule or a calendar, or reading a map and plotting out directions to a location.

“[They’re] literally practicing skills they should be able to do much easier, and it just takes them longer,” Stephanie says. “You kind of retrain their brain to do it at a better speed, a better rate and with more confidence.”

Speech-language pathology is key to COVID recovery

Nabil, Zubeen and Stephanie all say their caseloads have become more challenging during the pandemic, either with more patients, or sicker patients with more complex care needs, or both. And while they may not be first to mind when thinking of a COVID patient’s care team, their role is critical to recovery.

“Without speech pathology these patients will not be able to eat,” says Nabil. “It’s that simple. We are the ones who assess the swallowing and get people off the feeding tubes most of the time and get them back to what they enjoy the most, which is eating and drinking.”

And that, in addition to the work of helping people regain communication skills, has highlighted for Stephanie how necessary this work is.

“I have come to realize just how imperative speech pathologists really are to our patients and to COVID recovery.”

About the author

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Lindsay Smith