Rehabilitation & Covid-19
This blog post has been updated from August 2020 to include new resources provided by the American Speech-Language-Hearing Association to provide more insight about the extent of effects from Covid-19 and how speech-language pathologists are vital to the patient care process.
We are well over a year into the global pandemic known as Covid-19. Each day we are learning more about this disease and its impact on those who become infected. Initially, fever and respiratory illness were the only symptoms of the virus. Now, there is a laundry list of symptoms, not limited to congestion, loss of taste and smell, fatigue, sore throat, muscle aches, headache, shortness of breath, and the list goes on.
With this ever-growing list of symptoms, we are now discovering that COVID-19 is leaving its mark on multiple organ systems besides the lungs. What could this mean for the field of rehabilitative therapy, and specifically for speech-language pathologists (SLPs) who may encounter patients that have or still are recovering from COVID-19? SLPs have been on the front line of patient care, playing important roles in the comprehensive treatment of patients who survive the virus. Below are thoughts on how SLPs are included in care for Covid-19 patients, but note, there are still many answered questions.
Lung Damage: COVID-19 can cause pneumonia or respiratory distress in the sickest of patients. The lungs can fill with fluid, become inflamed, or leak, causing significant damage. Symptoms can persist in patients who survive COVID-19, with fatigue and shortness of breath being ongoing challenges for months after acute “recovery”. Could SLPs treat such patients in the future using techniques such as Respiratory Muscle Strength Training? What are the long term impacts of persistent respiratory deficits on swallowing and voicing for speech production? Could there be ongoing challenges for treatment of patients who were ventilated for extended periods of time? These may be areas of research that SLPs will encounter in the years to come.
Cardiovascular Problems: Issues with irregular heart beats and clotting have been observed in some COVID-10 patients. Similar to lung damage, fatigue and shortness of breath can occur with cardiovascular problems, but chest pain is also common. Heart muscles may have difficulty pumping blood or vessels may become blocked. Patients may experience heart attacks or strokes. These kinds of patients are already commonly treated by SLPs in acute care, inpatient/outpatient, assisted living, and home health settings. SLPs may need to work with patients given new deficits such as atypical speech patterns; difficulty verbalizing words or understanding conversations; feeding challenges; or reduced safety awareness and reasoning. The question is, will the course of recovery and SLPs’ methods of treatment look different given the many unknowns about COVID-19?
Kidney Damage: We may not often think about pre-existing conditions like diabetes being a precursor to speech therapy services. Patients with diabetes are at higher risk for developing kidney damage from COVID-19, which can potentially lead to chronic renal issues, strokes, and heart attacks. Outcomes can be similar to those seen in cardiovascular cases.
Neurological Changes: There isn’t enough research to determine if changes to the brain are permanent in patients diagnosed with COVID-19. I have personally worked with patients who have expressed lingering issues with chronic fatigue, brain fog, and trouble with cognition (e.g., attention, memory, organization) on a daily basis, issues that were not present prior to a diagnosis of Covid-19. Physicians and researchers have noted symptoms such as confusion, loss of taste/smell, seizures, agitation, and dizziness. SLPs may treat areas pertaining to cognitive endurance, self-awareness, mental agility, and problem solving. If deficits in these areas are present, do patients recover spontaneously after a period of time or is therapy warranted? What level of service intensity might patients require? What will therapy responsiveness look like for patients with mild versus severe cases?
SLP treatment of COVID-19 patients and survivors will be inevitable. We are already seeing patients treated through acute care, inpatient and outpatient settings, and private practices. Although we have lots of research pertaining to known treatment conditions which we can pull from, more information will likely be needed to guide treatment amid this novel virus, including patients’ course of care, history of recovery, and changes in functional status since hospitalization.
The American Speech-Language-Hearing Association has been diligently compiling information regarding patient care and Covid-19. Below are links to various resources that provide more insight into specific challenges that Covid-19 can inflict on the body, and how SLPs are addressing them. Cognition, Speech & Language offers free consultations pertaining to evaluation and treatment should you or a loved one have questions about Covid-19 and private therapy.
Covid-19: Impact & Patient Care Links
American Speech-Language-Hearing Association
Centers for Disease Control & Prevention
University of Miami Health News
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Devon Brunson, MS, CCC-SLP, CBIS
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