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Speech Language Pathology in the Neurocritical Care Unit

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A Correction to this article was published on 14 November 2023

This article has been updated

Abstract

Purpose of review

The aim of this study is to review the scope of practice of speech language pathologists (SLPs) in the daily practice of neurocritical care.

Recent findings

In patients with aphasia, impairment-based or function-based language interventions improve outcomes. Augmentative and alternative communication devices can help certain patients with severely impaired speech production. After tracheostomy, one-way speaking valves can be placed either in-line with a ventilator or after weaning; it has been shown that earlier placement is associated with faster decannulation. Swallow screening, bedside swallow evaluations, and instrumental swallowing evaluations such as videofluoroscopic swallow studies (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) are valuable tools for diagnosing dysphagia and identifying candidates for percutaneous enteral gastrostomy. Deficit-based rehabilitation of dysphagia is centered on re-training swallowing muscles and reorganizing neural synapses involved in swallowing function, capitalizing on the principles of neuroplasticity and motor learning. Neuromodulation therapies such as pharyngeal electrical stimulation can promote functional reorganization of cortical pathways involved in swallowing and show promise to improve swallow function and reduce aspiration risk.

Summary

SLPs are essential members of the multi-disciplinary neurocritical care team, particularly with regard to the evaluation and management of communication, cognition, and swallowing dysfunction.

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Fig. 1

Reproduced from Elpern EH, Borkgren Okonek M, Bacon M, Gerstung C, Skrzynski M. Effect of the Passy-Muir tracheostomy speaking valve on pulmonary aspiration in adults. Heart & Lung: the journal of critical care. 2000;29(4):287–93. https://doi.org/10.1067/mhl.2000.106941.

Fig. 2

Reproduced from Langmore SE, Schatz K, Olson N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2:216–19.

Fig. 3

Reproduced with permission from Phagenesis, Inc. on 6/2/23.

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Change history

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA

    Nicole Frost MA, CCC-SLP, BCS-S

  2. New York Medical College, Valhalla, NY, USA

    Gavin Yuan BA, Julie Zhang BA & Stephan A. Mayer MD

  3. Westchester Medical Center Health Network, 100 Woods Road, Taylor Pavillion E119, Valhalla, NY, 10595, USA

    Amy Rickard CCC-SLP, Erin McGee CCC-SLP, Michelle DiMattia CCC-SLP & Stephan A. Mayer MD

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  1. Nicole Frost MA, CCC-SLP, BCS-S
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Correspondence to Stephan A. Mayer MD.

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Dr Mayer reports receiving consulting fees from Phagenesis Inc, maker of a pharyngeal electrical stimulation device. The other authors have no conflicts to report.

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Frost, N., Yuan, G., Zhang, J. et al. Speech Language Pathology in the Neurocritical Care Unit. Curr Treat Options Neurol 25, 499–516 (2023). https://doi.org/10.1007/s11940-023-00772-5

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