Hyperacute Strokes and the Role of Speech Pathologists
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.
There is a high need for integration and collaboration in the provision of speech pathology services for hyperacute stroke patients. Primary stroke centers (PSC) and comprehensive stroke centers (CSC) are dedicated stroke-focused programs with integrated ER to ICU trends and bundles for best practice. This requires a team approach for advanced imaging, 24/7 available personnel, ICU/neuroscience, ICU facilities, and capabilities of experienced personnel in treating patients with a variety of strokes. Speech pathologist involvement with hyperacute stroke patients is paramount to initiate evaluations and treatment at the time of insult post tPA and/or thrombectomy. Collaboration and communication with the rehabilitation team are key for patient-centered care. Speech pathologists are highly suited to educate patients and their families regarding communication, cognition, and swallowing status at the onset of injury.
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. Stroke Prevalence and Current Data on Outcomes From Primary Stroke Centers
The theory behind a care bundle is that when several evidence-based interventions are grouped together in a single protocol, it will improve patient outcomes. Comprehensive and primary stroke centers provide focused care with expertise in treating stroke patients. These groups include, but are not limited to, ER, MD, RN, radiology, interventional radiology, neuro MD, pharmacy, and ICU medical teams. Stroke is also the leading cause of serious long-term disability in the United States. There are more than 7 million stroke survivors living in the United States, and two-thirds of them are currently disabled. Around 25% of people who recover after their first stroke will have another within five years. This chapter provides information regarding types and prevalence of strokes.
2. Evidence-Based ER Guidelines for Code Strokes
Early detection of stroke and getting to the ER is crucial in advancing best outcomes for hyperacute strokes. Code stroke activation as well as getting all the details correct and in a timely manner is crucial. The benefits of tPA in patients with acute ischemic stroke are time-dependent, and guidelines recommend a door-to-needle time of 60 minutes or less. This chapter will focus on national guidelines for hyperacute strokes in primary or comprehensive stroke centers.
3. Interdisciplinary Dyad With ICU RN and Speech Pathologist in a Code Stroke
The interdisciplinary dyad from ER RN to ICU RN to speech pathologist post tPA and/or thrombectomy is crucial in monitoring the patient’s neuro status for the first 24 hours after insult. Timing of an RN screen once in the ICU unit and communication with the screening results to the speech pathologist are essential. The speech pathologist’s role in evaluating communication, cognition, and ability to eat post procedures is crucial for early education to patients and their caregivers.
