Speech Language Pathology in the Hospital

As a hospital-based speech language pathologist, I am frequently asked, “You’re a speech language pathologist in a hospital?  What do you do?”  People often assume speech pathologists work in schools with children, but many of us don’t.  Speech pathologists are trained to work with people of all ages with a multitude of diagnoses.

Speech pathologists often see patients with the following diagnoses in a hospital setting:

1. Stroke
2. Traumatic brain injury
3. Injury, surgery, or cancer of the head/neck
4. Tracheostomy
5. Parkinson’s disease

Patients with these diagnoses frequently have difficulties with speech, language, voice, and swallowing.  Because speech pathologists know the anatomy of the head and neck so well, it’s a natural fit for us to evaluate the functions in these areas.

Swallowing

Because swallowing is a natural behavior, you have probably never thought about the many aspects of it.  Normal swallowing includes:

1. Timing: Timing is everything, especially when you’re eating or drinking.  In fact, normal swallowing happens so quickly that it’s not something we typically think about while we’re doing it!
2. Strength: The muscles in your mouth and throat need to be relatively strong in order to break food down and move it through your mouth and throat.
3. Range of Motion: In order for normal swallowing to occur, the muscles of the mouth and throat must move efficiently and to their fullest potential.
4. Sensation: We’ve all felt foods or liquids “go down the wrong way.”  The opening to the airway (for breathing) and the opening to the upper esophagus (for swallowing) are very close together. Highly sensitive tissue in this area alerts us if anything begins to go the wrong way. This causes us to cough in an attempt to protect the airway.
5. Coordination: The swallowing mechanism ultimately needs to work in a brisk, efficient, and well-coordinated manner over and over again throughout each day. 

When any of these are interrupted by illness or injury, it might result in a swallowing disorder. This would allow food or liquid to spill into the airway and may eventually result in aspiration pneumonia.

Speech pathologists perform swallowing evaluations to identify ways to decrease the risk of developing aspiration pneumonia.  This can be done in several ways:

1. Clinical Bedside Swallow Evaluation:  subjective evaluation performed by a speech pathologist at bedside, using varied consistencies of food or liquid.
2. Fiberoptic Endoscopic Evaluation of Swallowing (FEES):  instrumental evaluation performed at bedside by a speech pathologist in which a fiberoptic camera is used to view swallowing in real time.
3. Modified Barium Swallow Study (MBS):  instrumental evaluation performed in radiology by a speech pathologist and a radiologist using a kind of animated x-ray pictures known as video fluoroscopy.

Each of these exams provides different information and allows for individualized recommendations for each patient, which may include: 

1. Diet:  changes in texture or consistency of food and/or liquid.
2. Positioning:  optimal positioning for meals.
3. Maneuvers/Strategies:  to improve safety of swallowing.
4. Swallowing Therapy:  potential recommendations for therapy (strengthening exercises, education, strategies).

Inpatient and outpatient speech pathology services are available at all Lifespan affiliates.  To learn more, visit the audiology and speech-language pathology program at Lifespan online.