Speech-Language Pathology: Helping Patients After Stroke

“Speech Therapy? My speech is fine!”

This is the first reaction many patients have when a provider suggests they get evaluated by a licensed Speech-Language Pathologist (SLP). SLPs are trained to evaluate and treat patients of all ages who have a variety of problems. One of the most common misconceptions is that SLPs only see patients who are having difficulty with their speech. The truth is that our scope of practice covers so much more than that!

Stroke: A leading cause of speech and swallowing problems

Adult and geriatric patients who suffer from a stroke receive a referral for speech therapy during their hospitalization. Strokes often damage parts of the brain that are involved in swallowing as well as producing and understanding speech. These patients must receive a comprehensive assessment before they can be discharged. Up to 64% of stroke patients will experience some difficulty swallowing (technically known as dysphagia) as the result of their stroke.

Aspiration: a danger for many stroke patients

Stroke patients are at increased risk for aspiration or having food or liquids go “down the wrong way” as a result of damage caused by their stroke. In addition to being a choking hazard, these substances can lead to aspiration pneumonia, a life-threatening infection that makes breathing very difficult. SLPs are trained in the evaluation and treatment of dysphagia. Patients are typically educated on exercises to improve their swallowing ability and also on techniques to compensate for difficulty swallowing. Some patients may require an altered diet during rehabilitation. A Modified Barium Swallow Study (MBSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are instrumental examinations that SLPs routinely do to rule out aspiration and to evaluate how safely and efficiently the patient is able to swallow.

Difficulty communicating: addressing root causes

Stroke patients also are at risk for difficulty with communication and may experience cognitive disorders that make it hard to communicate. One of the key signs of stroke is that a person suddenly has trouble finding words, speaking clearly, and/or generating enough volume. SLPs evaluate and treat patients with aphasia (disorders that affect their ability to talk or understand language), dysarthria (weakness or loss of control of the muscles used for speech), cognitive impairments, and voice disorders. More about these below.

When a tracheostomy is required

Occasionally, a patient who has had a stroke requires a tracheostomy, a hole made surgically in the throat to assist in breathing. SLPs work with nursing staff, respiratory therapists, pulmonologists, and ear, nose and throat specialists (ENTs) to monitor the patient’s readiness for a Passy-Muir Valve (PMV). Simply put, a PMV is a special valve that helps patients with a tracheostomy improve and restore voice and speech production, secretion management, overall swallow function, and sense of taste and smell. It can be used for patients who need a ventilator and for patients who are able to breathe on their own. PMV can also help patients who are working towards decannulation, which is the removal of the tracheostomy. Once the PMV is attached to the tracheostomy, SLPs can assist patients with voicing and improved communication overall.

Aphasia: When words won’t come

You may have heard someone who has had a stroke say, “I know what I want to say, but I can’t say it.” Aphasia is a language disorder that can accompany a stroke. One-in-3 stroke patients may experience receptive and/or expressive language deficits to varying degrees. The type of aphasia they have depends on which parts of the brain were damaged by their stroke. The severity of aphasia also varies from patient to patient.

Patients and SLPs work together to find the most effective mode of communication for the patient. Some patients experience such severe difficulty speaking that they may require an augmentative and alternative communication device (AAC) to help supplement their expression. AAC devices can be low-tech or high-tech and are individually made according to the patient’s needs. These devices also can be modified over time. Assistive technology for communication is an ever-changing field as technological advances make it more effective for patients to communicate non-vocally.

Dysarthria: When speech sounds wrong

Dysarthria is a speech disorder caused by loss of muscle control and/or coordination that can affect a person’s ability to communicate. Patients report that sometimes their speech sounds slurred, choppy, or mumbled in comparison to their speech prior to their stroke. They may also report, “My speech sounds like I am drunk, but I haven’t had a drop of alcohol.” SLPs complete dysarthria evaluations and implement a personalized treatment plan that focuses on improving daily functional communication and ways to make speech clearer.

Cognitive problems: When the brain can’t cope

Cognitive impairments may occur in isolation or in conjunction with other communication disorders. Patients who suffer from a stroke can experience deficits in their visual-spatial awareness, orientation, safety awareness, reasoning, problem-solving, and/or executive function. Many patients also experience emotional changes (also referred to as lability). These impairments can impact their ability to complete tasks they were able to do prior to their stroke and can limit independence. SLPs are trained in evaluating and treating patients with cognitive impairments and providing skilled education about these disorders.

After hospitalization: Care for patient and family

Strokes impact not only the patient but the entire family. Imagine having to learn how to manage a new diet, an alternate method of communication, limitations with mobility, and unplanned emotional outbursts in public while still carrying on with your daily activities. These difficulties are not uncommon and can be challenging and frustrating.

SLPs work in conjunction with physical therapists, occupational therapists, social workers, respiratory therapists, palliative care professionals, dietitians, case managers, physicians, and nursing staff to assist the patient and family with recovery and coping after discharge. St. Mary’s Health Care System has SLPs working within all three of our hospitals, on the inpatient rehabilitation unit at St. Mary’s Hospital, at Good Samaritan Hospital’s swing-bed rehab program, in-home health care/hospice services, and in our outpatient rehabilitation center.

Whether you or a loved one needs SLP care in the hospital, in your home, or during regular outpatient visits, we are here to help.

Learn More

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• St. Mary’s Center for Rehabilitative Medicine – (706) 389-3555
• St. Mary’s Outpatient Rehabilitation Center – (706) 389-2950
• St. Mary’s Sacred Heart Hospital Rehab Services – (706) 356-7450
• St. Mary’s Good Samaritan Hospital Rehab Services - (706) 453-5088