How COVID-19 Patients Were Moved to Speak: A Rehabilitation Interdisciplinary Case Series

Abstract Background Up to 36% of patients admitted to the ICU for COVID-19 require tracheostomy. While the literature recommends the use of multidisciplinary teams in the management of patients with tracheostomy for other diseases, little is known on the collaborative administration of physical therapy and speech language pathology services in the COVID-19 population. Purpose We sought to determine the outcomes of a collaboration between physical therapy (PT) and speech language pathology (SLP) in the treatment of patients who underwent tracheostomy placement as part of their treatment for COVID-19 at our facility. Methods We conducted a retrospective case series on patients with COVID-19 who had a tracheostomy. We included patients who had undergone mechanical ventilation for 14 days or longer, had a surgical tracheostomy, been discharged from intensive care to a medical unit, and received PT and SLP referrals. We compiled retrospective data from electronic medical records, analyzing days from tracheostomy to achievement of PT and SLP functional milestones, including mobility, communication, and swallowing. Of six critically ill patients with COVID-19 who had tracheostomy placement at our facility, three met inclusion criteria: patient 1, a 33-year-old woman; patient 2, an 84-year-old man; and patient 3, an 81-year-old man. For all patients, PT interventions focused on breathing mechanics, secretion clearance, posture, sitting balance, and upper and lower extremity strengthening. SLP interventions focused on cognitive reorganization, verbal and nonverbal communication, secretion management, and swallowing function. Intensity and duration of the sessions were adapted according to patient response and level of fatigue. Results We found that time to tracheostomy from intubation for the three patients was 23 days, 20 days, and 24 days, respectively. Time from tracheostomy insertion to weaning from ventilator was 9 days for patient 1, and 5 days for patient 2 and patient 3. Regarding time to achieve functional PT and SLP milestones, all patients achieved upright sitting with PT prior to achieving initial SLP milestone of voicing with finger occlusion. Variations in progression to swallowing trials were patient specific and due to respiratory instability, cognitive deficits, and limitations in production of an effortful swallow. Patient participation in therapy sessions improved following establishment of oral verbal communication. Conclusion Interdisciplinary cooperation and synchronized implementation of PT and SLP interventions in three COVID-19 patients following prolonged intubation facilitated participation in treatment and achievement of functional milestones. Further study is warranted.

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Speech Pathology Services Are Integral, but Underutilized in Tracheostomy Rehabilitation

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520948381 ◽

2020 ◽

pp. 194338752094838

Author(s):

Stephanie Davis ◽

Ashleigh M. Weyh ◽

Salam O. Salman ◽

Firas Madbak ◽

John T. Fraker

Keyword(s):

Primary Outcome ◽

Case Series ◽

Speech Pathology ◽

Speech Language Pathology ◽

Retrospective Case ◽

Lower Odds ◽

Speaking Valve ◽

Language Pathology ◽

Swallow Study ◽

Secondary Outcomes

Study Design: Retrospective case series. Objective: Speech language pathology (SLP) is an underutilized but important component in rehabilitation after tracheostomy. The purpose of this study was to determine rates of SLP utilization and to streamline tracheostomy decannulation to be more efficient and safer through increased utilization of SLP. Methods: Adult patients who underwent tracheostomy from April 2016 to December 2018 were evaluated. The primary outcome was completion of any SLP evaluation after tracheostomy, and secondary outcomes were duration from surgery to evaluation, speaking valve and swallow study utilization, downsize and decannulation rates, mean duration of cannulation, and complications. Results: A total of 255 subjects were included, where 197 (77.3%) underwent SLP evaluation. A minority received a speaking valve (33.7%), while approximately half underwent a swallow study (52.9%). There was a delay in SLP evaluation, with mean duration from surgery to SLP evaluation of 5.9 ± 8.0 days. There was consistent improvement in downsize and decannulation rates in all cohorts that utilized SLP services. Tracheostomy indication of head and neck cancer, trauma, completing a successful swallow study conferred increased odds of eventual decannulation, while obesity and tracheostomy history conferred lower odds. An interdisciplinary decannulation pathway was created, based on literature review and results, to assist in decision-making while progressing toward decannulation. Conclusion: Speech language pathologists are underutilized for rehabilitation of tracheostomy patients, where they are able to offer many skills to diagnose, treat, manage, and troubleshoot, as patients advance through the decannulation process.

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Injection Laryngoplasty for the Treatment of Type 1 Laryngeal Clefts: A Single Institution Experience

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420973237 ◽

2020 ◽

pp. 000348942097323

Author(s):

Mohammad Al-Alawneh ◽

Ladd Caballero ◽

Elijah DeBroux ◽

Michael J. Herr ◽

Amy Claire Petro ◽

...

Keyword(s):

Case Series ◽

Secondary Outcome ◽

Injection Laryngoplasty ◽

Single Institution ◽

Retrospective Case ◽

Swallowing Function ◽

Post Operation ◽

Gel Injection ◽

Number Of Injections

Objective: Standards for treatment of laryngeal clefts remain poorly defined. There are no large case series that report the efficacy of injection laryngoplasty (IL) in the treatment of pediatric Type 1 laryngeal clefts (LC-1). The objective of this study is to measure the effect of IL in young children with LC-1. Methods: A retrospective case series of 130 patients was completed over 3 years at a at a single institution included patients aged 1 month to 8 years, diagnosed with aspiration and penetration issues during swallowing based on a Videofluoroscopic Swallow Study (VFSS). Patients underwent surgical evaluation and intervention using carboxymethylcellulose gel injection. Collected data points included age in months at time of first injection, gender, race, pre- and post-operation VFSS scores, number of injections, co-morbidities and post-operative complications. VFSS scores were evaluated pre- and post-operatively to assess efficacy of intervention. A secondary outcome was efficacy in patients with aspiration compared to those with penetration alone. Results: This study included 77 male and 53 female patients. Sixty-two patients (48%) demonstrated a significant post-operative improvement in their swallowing function ( P < .05). There were no statistical differences in age, number of injections, or the volume of the first injection. Patients that showed a post-operative improvement in swallowing function were on average 5 months older and had more severe aspiration and penetration compared to those who did not demonstrate a post-operative benefit and underwent less injections. The volume of injection did not appear to play a role in the success rate. Conclusion: Injecting the inter-arytenoid area in patients with LC-1 appears to confer some benefit to close to half of our patient population. Successful procedures seemed to occur in patients with more severe aspiration and penetration and older age.

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Conservative management of De Quervain’s tendinopathy with an orthopedic manual physical therapy approach emphasizing first CMC manipulation: a retrospective case series

Physiotherapy Theory and Practice ◽

10.1080/09593985.2020.1771800 ◽

2020 ◽

pp. 1-10

Author(s):

Scott W. Young ◽

Thomas W. Young ◽

Cameron W. MacDonald

Keyword(s):

Physical Therapy ◽

Conservative Management ◽

Case Series ◽

Retrospective Case ◽

Therapy Approach ◽

Retrospective Case Series

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Book Review: Developing Continuing Professional Education in Physical Therapy, Occupational Therapy and Speech-Language Pathology/Audiology

Canadian Journal of Occupational Therapy ◽

10.1177/000841748705400518 ◽

1987 ◽

Vol 54 (5) ◽

pp. 273-273

Author(s):

Jane O'Callaghan

Keyword(s):

Physical Therapy ◽

Occupational Therapy ◽

Professional Education ◽

Continuing Professional Education ◽

Speech Language Pathology ◽

Language Pathology

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Manual Therapy and Exercise to Improve Outcomes in Patients With Muscle Tension Dysphonia: A Case Series

Physical Therapy ◽

10.2522/ptj.20130547 ◽

2015 ◽

Vol 95 (1) ◽

pp. 117-128 ◽

Cited By ~ 21

Author(s):

Carey A. Tomlinson ◽

Kristin R. Archer

Keyword(s):

Physical Therapy ◽

Manual Therapy ◽

Rating Scale ◽

Muscle Tension ◽

Case Series ◽

Vocal Folds ◽

Patient Specific ◽

Meaningful Improvement ◽

Muscle Tension Dysphonia ◽

Patient Reported

Background and Purpose Muscle tension dysphonia (MTD), a common voice disorder that is not commonly referred for physical therapy intervention, is characterized by excessive muscle recruitment, resulting in incorrect vibratory patterns of vocal folds and an alteration in voice production. This case series was conducted to determine whether physical therapy including manual therapy, exercise, and stress management education would be beneficial to this population by reducing excess muscle tension. Case Description Nine patients with MTD completed a minimum of 9 sessions of the intervention. Patient-reported outcomes of pain, function, and quality of life were assessed at baseline and the conclusion of treatment. The outcome measures were the numeric rating scale (NRS), Patient-Specific Functional Scale (PSFS), and Voice Handicap Index (VHI). Cervical and jaw range of motion also were assessed at baseline and postintervention using standard goniometric measurements. Outcomes Eight of the patients had no pain after treatment. All 9 of the patients demonstrated an improvement in PSFS score, with 7 patients exceeding a clinically meaningful improvement at the conclusion of the intervention. Three of the patients also had a clinically meaningful change in VHI scores. All 9 of the patients demonstrated improvement in cervical flexion and lateral flexion and jaw opening, whereas 8 patients improved in cervical extension and rotation postintervention. Discussion The findings suggest that physical therapists can feasibly implement an intervention to improve outcomes in patients with MTD. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the intervention. A clinical implication is the expansion of physical therapy to include referrals from voice centers for the treatment of MTD.

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Speech–Language Pathology Evaluation and Management of Hyperkinetic Disorders Affecting Speech and Swallowing Function

Tremor and Other Hyperkinetic Movements ◽

10.5334/tohm.381 ◽

2017 ◽

Vol 7 (0) ◽

pp. 489 ◽

Cited By ~ 6

Author(s):

Julie M. Barkmeier-Kraemer ◽

Heather M. Clark

Keyword(s):

Speech Language Pathology ◽

Swallowing Function ◽

Language Pathology

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Cotreatment as a Vehicle for Interprofessional Collaborative Practice: Physical Therapists and Speech-Language Pathologists Collaborating in the Care of Children With Severe Disabilities

American Journal of Speech-Language Pathology ◽

10.1044/2017_ajslp-15-0179 ◽

2017 ◽

Vol 26 (2) ◽

pp. 206-216 ◽

Cited By ~ 5

Author(s):

Lorraine Sylvester ◽

Billy T. Ogletree ◽

Karen Lunnen

Keyword(s):

Physical Therapy ◽

Physical Therapists ◽

Severe Disabilities ◽

Collaborative Practice ◽

International Classification Of Functioning ◽

Speech Language Pathology ◽

Speech Language Pathologists ◽

Interprofessional Collaborative Practice ◽

Language Pathology ◽

Accepted Practice

PurposeThis article defines interprofessional collaborative practice and links its key features with accepted practice conceptualizations of physical therapy. Cotreatment with speech-language pathology is described as a vehicle for interprofessional collaborative practice for children with severe disabilities.MethodThe article reviews the International Classification of Functioning, Disability, and Health (WHO, 2015) and the Hypothesis-Oriented Algorithm for Clinicians II (Rothstein, Echternach, & Riddle, 2003) as existing service-delivery frameworks in physical therapy and discusses how interprofessional collaborative practice between speech-language pathologists and physical therapists can be useful within these practice guidelines.ResultsA case illustration featuring interprofessional collaborative practice during cotreatment for a child with severe disabilities through physical therapy and speech-language pathology showed more seamless care and better progress in the pursuit of three main goals: physical movement, communication of needs, and participation in classroom activities.ConclusionsInterprofessional collaborative practice is supported as a recommended practice methodology for physical therapists and speech-language pathologists serving persons with severe disabilities.

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S193 – Voice and Swallowing after Jugular Foramen Surgery

Otolaryngology ◽

10.1016/j.otohns.2008.05.367 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P140-P140

Author(s):

Yael Oestreicher-Kedem ◽

Edward J Damrose ◽

Sumit Kishore Agrawal ◽

Robert K Jackler

Keyword(s):

Preoperative Evaluation ◽

Voice Quality ◽

Cranial Nerves ◽

Tube Feeding ◽

Case Series ◽

Jugular Foramen ◽

Retrospective Case ◽

Swallowing Function ◽

Swallowing Rehabilitation

Objectives This study was designed to evaluate the role and timing of surgical procedures for voice and swallowing rehabilitation in patients after surgery for jugular foramen tumors. Methods A retrospective case series. The records of patients operated for jugular foramen tumors from January 2002 to February 2008 were reviewed for lower cranial nerves function, hoarseness, dysphagia and aspiration, recovery course and rehabilitation procedures. Results 17 patients underwent surgery for jugular foramen tumors. Tumors included 12 glomus jugulare, 4 schwannomas and 1 meningioma. 3 patients had presented with vagal and glossopharyngeal paralysis and 6 more patients developed post-operative paralysis. All patients with paralysis experienced dysphagia and hoarsheness. 6 experienced aspiration. Gastrostomy or nasogastric tube feeding were required in 3 patients. 7 patients did not recover nerve function by the end of follow-up. Treatments to improve voice and swallowing included vocal cord medialization by collagen injection (n=3), thyroplasty type 1 (n=5) with arytenoid adduction (n=4), cricopharyngeal myotomy (n=2), and palatal adhesion (n=3). Conclusions Postoperative dysphonia, dysphagia, and aspiration are common in patients after surgery for jugular foramen tumors. Most patients are unlikely to regain vagal or glossopharyngeal nerve functions at 1 year of follow-up, and will eventually elect to undergo corrective surgery to improve voice quality and swallowing function. Preoperative evaluation and close postoperative follow-up by an experienced laryngologist will help identify patients who will benefit from early surgical rehabilitation.

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