The Role of a Speech Pathologist in Stroke Rehabilitation

Stroke is one of the leading causes of long-term disability and can have a serious impact on quality of life.

Along with the various physical challenges that survivors face, communication and swallowing difficulties are a common result of stroke. In such instances, speech pathologists play a crucial role in helping patients regain their ability to communicate and swallow effectively. With specialized knowledge and expertise, speech pathologists facilitate the recovery process and help stroke survivors reintegrate into their social and professional lives.

Understanding Speech Pathologist's Role in Stroke Rehabilitation

When an individual experiences a stroke, the brain's normal functioning can be compromised, leading to difficulties in speech, language, cognition, and swallowing. Speech pathologists are the professionals trained to assess, diagnose, and treat various communication and swallowing disorders. Your speech pathologist will conduct an assessment to diagnose your communication or swallowing impairments, collaborate with you and the medical team on a plan of care, plan tailored treatment sessions to maximize your progress, and provide ongoing support and education throughout your recovery.

ASSESSMENT

A speech pathologist will conduct a comprehensive evaluation to not only determine impairments in communication, cognition, and swallowing caused by the stroke, but also gather information about your prior function, what your needs and preferences are, and provide guidance in setting collaborative, attainable goals within a framework that is specific to your needs. Information may be gathered through medical records, motivational interviewing, standardized assessments, informal assessments, patient-reported outcome measures, and cranial nerve examination in order to establish a baseline and formulate a personalized treatment plan.

If you are experiencing difficulty swallowing, an instrumental assessment is necessary to correctly diagnose your swallow impairment and develop a treatment plan. There are two different types of instrumental evaluation:

Videofluoroscopic Swallow Study (VFSS), also known as Modified Barium Swallow Study (MBSS) is the evaluation of swallow function using X-ray imaging. This is usually performed during your hospital stay or as an outpatient study at the hospital, but there are also some mobile services available depending on your area. The evaluating speech pathologist will provide you with different foods and liquids with barium to swallow and provide instruction. Afterward, you will be guided through portions of the video explaining any swallow impairments, provided recommendations, and a copy of the speech pathology report should be sent to your primary physician. If possible, obtain a copy of the speech pathology report to give to your treating speech pathologist to ensure that he or she has all of the diagnostic information to form an effective treatment plan.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) utilizes a tiny camera through the nose to directly visualize the throat during swallowing. This exam can be performed in outpatient offices and in mobile practices, and because it is a portable system and does not require radiology equipment, can often be a more accessible option. The speech pathologist will provide you with dyed food and liquids to assess your swallow with direct visualization. The video will be reviewed with you to enhance your understanding of any identified impairments and help guide your decision-making process moving forward.

Each of these instrumental assessments has its pros and cons, and your speech pathologist may make a determination that one may be more beneficial than the other, or even that both may be necessary, depending on your specific presentation or complaints.

REHABILITATION

Speech pathologists work with stroke survivors to redevelop their speech, language, cognitive, and swallowing skills. Therapy forms a significant part of the rehabilitation process for stroke survivors. Through a series of structured sessions, the speech pathologist instructs the patient through specific exercises with determined targets guided by the principles of neuroplasticity. Neuroplasticity refers to the brain's ability to reorganize itself by forming new neural connections (essentially re-wiring the brain). This remarkable property of the brain has significant implications for rehabilitation after injury or in the context of various neurological conditions.

10 Principles of Neuroplasticity

1. USE IT OR LOSE IT - Neural pathways that are frequently used are strengthened, while those that are rarely activated may weaken or even disappear.

This is why it is SO important that a person keep swallowing SOMETHING if at all possible, even if it is just ice chips or small sips of water in order to avoid disuse atrophy of muscles and maintain neural connections.

2. USE IT AND IMPROVE IT - Training that drives a specific brain function can lead to improving abilities.

We have the ability to improve any skill. The more you practice, stronger those neural connections become.

3. SPECIFICITY - The nature of the training or rehabilitation program should be tailored to the specific skill or function that needs improvement.

If you want to improve your ability to swallow, you have to swallow! Advances in research

support the fact that non-swallowing exercises alone are not effective in improving swallow function.

4. REPETITION - Regular and repeated practice of a specific activity or skill can lead to the reorganization of neural pathways and improvement in that particular function.

This means repeating the same movement, the same word, or the same swallow exercise

over and over again! While it may feel monotonous, think about how you may have become really good at a sport. Want a good golf swing? How many times do you think you have to swing that club before your muscles know what to do automatically? 100? 500? 1,000 times?

5. INTENSITY - The intensity of training or therapy can significantly influence the extent of neuroplastic changes in the brain.

Intensity of exercises should increase as your skills progress. Depending on what skill you

are trying to improve, there are several ways your speech pathologist can increase the challenge of the exercise. Maybe this looks like increasing the number of swallows per session or advancing the complexity of reading material from simple sentences to short paragraphs.

6. TIME - It is important to begin therapy as soon as possible and understand that it may take time to see obvious improvements as the brain heals.

You will see the most observable improvements in the months immediately following injury; however, there is no limit to neuroplasticity and your brain has the ability to continue making changes throughout your life.

7. SALIENCE - Therapy must be meaningful to the person in order to cause change.

It is vital that you are invested in the therapy process in order to make meaningful gains. It is the speech pathologist's job to ensure that you are provided relevant therapy materials and exercises that are interesting to you. If you are trying to improve your communication skills, it is important to engage in conversation about things you care about!

8. AGE - While neuroplasticity is more pronounced in younger individuals, it remains a lifelong process, and significant improvements can be achieved through targeted rehabilitation even in older adults.

Change is possible at any age!

9. TRANSFERENCE - Change in function as a result of one training experience can even lead to learning other similar skills or generalizing skills across contexts.

This is an important principle to consider for aphasia. Language is connected - so practicing one skill area (like describing items as a therapeutic exercise) leads to improvement in other areas (being able to name specific items in conversation).

10. INTERFERENCE - Plasticity in response to one training experience can impede acquisition of similar behaviors.

If treatment in delayed, sometimes your brain will adapt a compensatory behavior for skill deficits that may not be efficient. The challenge of learning a new skill may involve unlearning a behavior.

EMPOWERING PATIENTS AND CAREGIVERS

Beyond direct therapy, speech pathologists play a vital role in empowering both patients and their caregivers by providing education about the nature of their disorder, advocating for patient's rights of decision-making in regards to their own healthcare, and providing support and resources for optimizing communication and managing dysphagia in daily life. This education and support ensures that the rehabilitation process continues even outside the therapy sessions, promoting a holistic recovery approach.

The journey of stroke recovery is often challenging,

but with the expertise and support of a dedicated speech pathologist, patients can significantly improve their cognitive and communication skills, ability to swallow safely and effectively, and overall quality of life. Through knowledge, compassion, and commitment, speech pathologists serve as beacons of hope for stroke survivors, helping them reclaim their voice and reconnect with the world.

If you are in Palm Beach Gardens, Jupiter, North Palm Beach, Juno Beach, Palm Beach, or surrounding areas, we can come to you! CCSS provides mobile speech therapy services in the convenience of your home. We also provide teletherapy to all Florida residents.

Book an appointment today!

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