Laura Thorburn, M.S., CCC-SLP
When a person is rushed to the hospital for a medical emergency, they’re usually evaluated by a variety of doctors. If the person is experiencing changes in swallowing, communication, cognition, or speech, they will also be assessed by a speech-language pathologist.
A speech-language pathologist also might be called an SLP, speech pathologist, speech therapist, or swallowing specialist. They’re a crucial part of the health care team that works within the intensive care unit (ICU). Their expertise goes beyond traditional speech therapy, including a range of critical functions that support patient recovery and improve quality of life.
This article explains the role of speech therapists in the ICU, the types of patients they help, and the treatments they provide.
What does an SLP do in the ICU?
Once a person is admitted to the hospital, the immediate goal is to diagnose their problem and begin treatment. The patient will be evaluated and monitored by doctors, nurses, specialists, counselors, and others. At any point during their stay, a patient may be referred to speech pathology because of concerns with communication, swallowing, or cognitive functioning.
Here are some common reasons a person may see a speech therapist in the hospital:
Difficulty with swallowing (called dysphagia)
Trouble with swallowing can lead to malnutrition, dehydration, or aspiration pneumonia. Swallowing safety should be checked as soon as the person is admitted to the hospital.
If a patient is struggling with certain food or liquid textures, diet changes may be needed. The patient may need to do special exercises, postural changes, or maneuvers in order to eat and drink safely. They will be monitored by a speech therapist, who may continue to adjust their diet as needed throughout their stay in the hospital. In many cases, the person will also receive diet recommendations when they’re discharged.
Communication challenges
An ICU patient may be unable to speak for a variety of reasons. For example, they may need intubation or a tracheostomy, which prevents them from talking due to changes in air flow. A neurological condition may affect a person’s ability to speak clearly or find the words to communicate.
Speech therapists work with these patients in the ICU to establish some form of communication. This might be a “low-tech” option, such as drawing or pointing, or a high-tech option, such as using a communication device.
Cognitive impairments
Patients who experience cognitive changes may pose a safety risk to themselves and others. Their symptoms may include poor decision making, confusion, disorientation, or difficulty remembering information. While cognitive changes may resolve in hours or days, a speech therapist can determine the severity of these problems, then train any professionals and caregivers in how to help compensate for them. These strategies might include note-taking, calendars, written signs, or pictures.
Which ICU patients need a speech therapist?
Speech therapists work with a diverse population of patients who are in intensive care for reasons such as the following.
Neurological conditions: The largest group of ICU patients seen by a speech pathologist are those with neurological conditions. These include stroke, traumatic brain injury, or neurological diseases such as amyotrophic lateral sclerosis (ALS) or Parkinson’s disease. These conditions can cause problems with swallowing, cognition, or communication.
Respiratory compromise: Patients who have been intubated or have respiratory issues that affect swallowing and communication will likely see a speech therapist. These patients need ventilators, tracheostomies, or oxygen support with a nasal canula or mask. These devices can make it hard to speak.
Post-surgical: Patients recovering from head, neck, or heart surgeries may need a tracheostomy or respiratory support.
Critical illness: Severe infections, sepsis, or multi-organ failure can affect cognitive and communication abilities. These ICU patients may be confused, disoriented, and forgetful. A speech therapist can ensure staff is aware of these problems and help them use the right strategies to keep the patient safe and comfortable.
By addressing swallowing, communication, cognitive, and voice disorders, speech therapists contribute to the recovery and quality of life of ICU patients. Their care not only helps with immediate patient outcomes, but also provides long-term benefits, supporting patients as they go through the stages of recovery. SLPs play a critical role in ensuring that all aspects of a patient's needs are met with expertise and compassion
