Acute Strokes and the Role of the Speech Pathologist
Presented by Jo Puntil
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Nonfinancial: Jo Puntil is an AB-SSD reviewer for specialty certification for swallowing and swallowing disorders. She is a reviewer for AJSLP, DRS for possible publication; a member of SIG 13, DRS; and past chair of the CFCC ASHA council. She has no competing nonfinancial interests or relationships with regard to the content presented in this course.
Due to the high prevalence of strokes in the United States, there is a high need for integration and collaboration in the provision of speech pathology services for stroke patients. Integrated MD, RN, physical, occupational, speech, and social work/case manager services are best practice for a primary or comprehensive stroke center. Speech pathologist involvement with acute stroke patients is paramount to initiate evaluations and course of treatment at the time of admission to the hospital, hopefully on the acute neuro unit. Collaboration and communication with the rehabilitation team are key for patient-centered care. An integrated team approach helps to decide if a patient can tolerate an intense inpatient rehabilitation program, skilled nursing facility, or home with home health/outpatient therapy. Speech pathologists are highly suited to educate patients and their families regarding communication, cognition, and swallowing status post stroke.
Meet your instructor
Jo Puntil
Jo Puntil is an ASHA Fellow, past chair of the CFCC, and a board-certified specialist in swallowing and swallowing disorders. She has extensive experience in developing interdisciplinary rehab programs/teams throughout southern California and Utah, specifically in the areas of critical and acute care. Jo has lectured…
Chapters & learning objectives
1. Prevalence and Epidemiology
The theory behind a care bundle for primary or comprehensive stroke centers is that when several evidence-based interventions are grouped together in a single protocol, it will improve patient outcomes. The annual incidence of stroke in the United States is approximately 795,000. Costs of stroke care, direct and indirect, increase yearly. According to the CDC, as of 2014–2015, it was approximately $46 billion due to cost of healthcare, medicine, and missed work. Types of strokes and highest risk factors will be covered.
2. Comprehensive Communication and Cognitive Evaluation
Stroke is the leading cause of disability in adults and often results in cognitive and communicative impairments. Thorough comprehensive evaluation of the patient’s communication, pragmatics, and cognition is imperative for determining the next level of care. Patients with mild stroke are assumed to achieve full recovery with little intervention. Patients with mild stroke may experience persistent disability and difficulty with complex activities, especially in executive functions to return to work or activities of daily living. The speech pathologist plays a key role in assessing the patient’s status with an acute stroke, educating the patient and family about their “new normal,” assisting with goals of care, and determining next level of care.
3. Clinical Bedside Evaluation
Dysphagia is a common poststroke condition, with a reported incidence of 37%–78%. Poststroke dysphagia is associated with increased mortality, comorbidities, poorer outcomes, decreased quality of life, longer hospital stays, higher medical expenses, and decreased social and psychological well-being. A comprehensive clinical bedside swallowing evaluation should include extensive motor and sensory cranial nerve assessments, trial feedings with a variety of consistencies, patient preferences, premorbid conditions, and of course, the patient’s cognition/communication skills. Decision on route of alimentation, instrumental evaluation, and consideration of the pragmatics of the patient's rehab course will be discussed.
4. Interdisciplinary Team Management and Goals: Decision-Making for the Next Level of Care
When multiple healthcare professionals work together to achieve patient-centered care, optimal outcomes are achieved. Communication with the rehab team, which includes MD, RN, physical therapy, and occupational therapy, periodically throughout the patient’s acute rehabilitation is needed due to the medical fragility of these patients. Helping the patient determine achievable goals guides them in a positive direction so they can transfer to the next level safely. Team collaboration daily is the key to success.
