THE CONDITIONS SPEECH THERAPY TREATS IN HOME HEALTH
“Mom doesn’t need a speech therapist! She talks just fine!”
This is a phrase I hear frequently as a Speech Language Pathologist (SLP). Don’t let our title fool you – as home health speech therapists, we can more accurately be called, “Speech-Language-Voice-Swallowing-Memory Therapists.”
Speech therapy is a critical piece of the home health care puzzle, helping patients regain independence and quality of life in multiple aspects. Let’s take a look at a few impairments that speech therapists address in the home health care setting.
CONDITIONS SPEECH THERAPY TREATS
- Dysphagia – Difficulty Swallowing
- Dementia – Memory and Cognitive Deficits
- Dysarthria – “Understandability”
- Aphasia – Language Difficulty
- Dysphonia and Aphonia
1. Dysphagia – Difficulty Swallowing
Patients who undergo head and neck cancer surgery, radiation and chemotherapy often have trouble in at least one phase of the swallowing process.
Swallowing is broken into three phases: oral, the pharyngeal swallow and the esophageal stage. Our goal is for the patient to consume the most lenient solid and liquid consistencies with the least amount of risk of choking.
SLPs often recommend diet changes, assign oral and/or pharyngeal exercises and recommend positional or behavioral strategies to reduce the risk of choking or aspiration.
Patients with respiratory diseases are at a higher risk of aspirating because the systems we use to breathe and swallow are close to each other and require precise timing. In these cases, and particularly with our COVID-19 patients, speech therapists may recommend a resistive breathing device to maximize safety.
2. Dementia – Memory and Cognitive Deficits
Patients with dementia often experience memory or cognitive deficits. The course of treatment will depend on the stage of the disease.
In the early stages, the speech therapist will focus on providing education to the patient and family on how the disease progresses, resources available for support and memory aides to help the patient remain as safely independent as possible. This is often through teaching memory strategies for taking medications accurately, remembering to take blood sugar, using the walker or even the phone or emergency alert device.
In the later stages, the focus turns to educating family on the best ways to interact with the patient and environmental changes that can decrease unsafe or fearful behaviors.
3. Dysarthria – “Understandability”
The speech impairment resulting in slurred speech is known as dysarthria. This disorder is caused by muscle weakness making it difficult to articulate speech and can result from neurological diagnoses like ALS.
As speech therapists, we develop plans of care that can include oral motor exercises and compensatory speech strategies, all with the goal of facilitating functional speech intelligibility.
4. Aphasia – Language Difficulty
Aphasia is difficulty expressing and understanding language and is often caused by strokes. This impairment can have severe consequences for our patients’ quality of life. Imagine you’re chair-bound and feeling cold, thirsty or in unusual pain and you can’t convey anything to your caregiver.
With maximizing communication as the long-term goal in mind, speech therapists devise activities and exercises to improve patients’ ability to understand and express language.
Simultaneously, the SLPs will also work with the patient and caregiver on alternative communication methods while the patient improves, which can include everything from simple picture books to advanced augmentative and alternative communication devices.
5. Dysphonia and Aphonia
Parkinson’s patients can experience dysphonia, or the abnormal production of voice, caused by weakness and decreased coordination of the muscles that control respiration and the vocal cords. Speech therapists will often use various feedback methods like sound meters while implementing a stringent home exercise program.
On the other hand, aphonia is the absence of voice production, often the result of having the larynx removed. To replace the voice box function, SLPs teach patients to use a vibrating electrolarynx or esophageal speech.
These examples merely scratch the surface of the types of patients who can benefit from speech therapy. Always consider your patients, their needs and their specific deficits.
Consider these questions:
- Are they falling frequently because they forget to use the walker?
- Are they on pureed solids or thick liquids?
- Have they had multiple bouts of pneumonia?
- Do you have trouble hearing or understanding them?
- Do they seem non-compliant with medication or disease management?
If yes, they may be appropriate for a speech therapy referral.