Introduction:
For persons who struggle with communication, feeding, and swallowing to reach the full potential, speech and language therapists offer examination, diagnosis, therapy, and support at all stages of life. In this context, human communication refers to all the activities involved in understanding and using both oral and written language and nonverbal and/or alternative forms of communication. Swallowing and communication are broad concepts that cover a variety of physiological functions. Speech enunciation and fluency, language, thought, resonance in the voice, and hearing are all aspects of communication. All aspects of swallowing, including associated feeding behaviors, are included in swallowing.
What Is the History of Speech and Language Therapy?
Speech and Language Therapy (SLT) began in the nineteenth century to correct speech issues caused by elocution and medical diseases. As the critical care environment has transitioned from primarily unconscious and ventilated patients who cannot speak or eat to a more active recuperation setting, difficulty swallowing and communication impairment have been highlighted. However, the significance of Speech and Language Therapists (SLTs) in this setting must be more recognizable. SLTs, like other therapeutic colleagues, should be included in the early examination of laryngeal function to reduce the burden of oropharyngeal dysphagia (difficulty in swallowing) and aspiration. Various therapies are available to help patients regain speech and swallowing function, which is the primary goal for those seeking a return to normal function.
What Is the Impact of Speech and Language Therapy in the Intensive Care Unit?
Examination, rehabilitation, and guidance in the critical areas of communication, swallowing, and tracheostomy weaning are all part of the SLT's work in the ICU.
Problems With Communication:
A successful communication path for all patients receiving critical care is made possible by early rehabilitation with the support of SLT. This is crucial to maximize psychosocial wellness, participation in daily care, and consent decisions. Communication problems in critical care are a significant source of stress, as is well known. Correlations between delirium and patients with communication problems have been found.
SLTs conduct formal and informal evaluations of responsive and expressive languages, speech, voice, and cognitive communication abilities (verbal and nonverbal). When a patient is awake and trying to communicate while still being intubated, help with communication may sometimes start. The next step will be to create a nonverbal communication channel to facilitate interaction with family members, friends, and staff stationed at the unit.
Nonverbal communication options can range from relatively simple approaches like the partner-assisted alphabet or picture chart scanning to technologically advanced ones like pillow switches and iPads, depending on the patient's ability and access methods. Training family members and workers to consistently use a good communication channel once it has been set up is crucial. Patients rely on communication partners and surroundings to make other communication possible.
Speech is the most efficient form of communication, and for people with tracheostomies, this is only possible when the cuff is deflated. This can be accomplished gradually as part of a procedure known as laryngeal weaning, which involves a collaborative team effort between SLTs and respiratory physiotherapists to assess the patient's larynx and respiratory system. This contrasts with respiratory weaning, in which the cuff is left inflated while the patient learns to breathe independently. Above-cuff Vocalization (ACV) is a short-term substitute that employs an external air source through a subglottic suction port to accomplish phonation while the tracheostomy cuff is still inflated. Additionally, this has been shown to improve laryngeal functions related to swallowing.
Difficulty in Swallowing:
Evaluation of oropharyngeal swallow function is one of the significant responsibilities of the SLTs in the intensive care unit. This comprises testing for the compatibility of oral meals and fluids and the capacity for swallowing and controlling oral secretions. SLTs can perform instrumental assessments of swallowing in addition to bedside evaluations. These exams offer a more in-depth perspective of the functional anatomy and physiology for swallowing utilizing a variety of textures, which then guides a tailored intervention.
In the department of radiology, Videofluoroscopy (VFS) uses radio-opaque substances incorporated into food textures that are given orally to the patient while the pathway of food is video captured to emphasize the patient's ability to handle food, swallow effectively, protect airways, and allow food to reach the esophagus.
Due to its portability compared to VFS and the extra advantage of precisely viewing dynamic pharyngeal and laryngeal architecture and secretion management, fibreoptic endoscopic evaluation of swallowing, or FEES, is a precious technique within the intensive care unit. This can help clinical judgments for patients weaning off ventilation and tracheostomy and frequently points out problems that can be fixed. SLTs conducting a FEES examination might suggest medication to control excessive secretions and therapeutic swallowing procedures to improve swallowing by reinforcing the base of the tongue, pharyngeal constriction, and laryngeal range of motion. To treat dysphagia, the SLTs look for aspiration signs and symptoms and alert the team that a choice must be made regarding whether to continue with oral intake.
Assisting With Tracheostomy Weaning:
The existence of a tracheostomy (a medical technique that entails making a hole in the neck so that a tube can be inserted into the trachea, or windpipe, of the patient) affects swallowing and communication by rerouting airflow and changing the valving and pressure systems that supply power to the muscles involved in typical swallowing. SLTs bring specialized knowledge and awareness of this physiology to the decision-making process regarding tracheostomy manipulation for weaning. By enabling cuff deflation and using one-way valves for phonation, SLTs can improve communication. Similarly, trans-laryngeal airflow aids in reactivating the laryngeal reflexes for coughing and swallowing to improve airway security. When combined with respiratory muscle training and biofeedback instruments, rehabilitation of speech and swallowing intensely raises patients' feelings of well-being and perceived quality of life, allowing them to resume everyday social interactions once more.
Conclusion:
As patients with complicated impairments are less sedated and exhibit speech and swallowing problems, the role of speech and language therapy in critical care has grown. These functions are typically viewed as a return to normalcy during rehabilitation and a measure of quality of life. To provide early rehabilitation for speech and swallowing, SLTs collaborate with physiotherapy, occupational therapy, nursing care, pharmacy, and dietetics in several teams. Early measures will help to avoid problems and shorten hospital stays. SLTs also contribute professionally to decision-making and rehabilitation objectives throughout the patient's pathway. This is especially true given that they frequently work through wards and might accompany the patient through rehabilitation as they transition into the community.
