The Role of Speech Pathology in the ICU: Acquired Brain Injuries
Presented by Jo Puntil
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Non-Financial: Jo puntil is a past chair of the ASHA CFCC Council, and a DRS Program committee member (2020–2021). She is a Reviewer of Applications for Board Specialty in Swallowing/Swallowing Disorders, and a reviewer for AJSLP and DRS for possible publication. She is also a SIG 13 Member.
There is an extensive need for integration and collaboration for the provision of all rehab services in the ICU. Patients with acquired brain injuries, including but not limited to concussion, mild to severe TBI, stroke, brain tumors, and head bleeds benefit from integrated rehabilitation evaluations. Speech pathologists are crucial for assisting the ICU team to focus on patient-centered care, communication with the medical team, and educating the patient/family regarding the next level of care. Speech pathologists are needed at the initiation of the patient's insult to provide communication with the patient and their families throughout the continuum of care. Speech pathology evaluations should encompass communication, cognition, and swallowing, which is paramount in the initial stages of an acute brain injury; that and extensive family education provides a more successful transition for the patient's next level of care. Any speech pathologist that works with acquired brain injuries is an applicable audience for this course. This course will provide an overview of acquired brain injuries from mild to severe, evaluation and documentation practices for communication, cognition, and swallowing. Strategies for effective interdisciplinary communication and collaboration is reviewed.
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. Acquired Brain Injuries From Mild to Severe
Mild to severe injuries to the brain are extremely common and seen daily in an ICU unit. Speech pathologists are key players of the team to evaluate the patient and help them identify the somatic, affective, cognitive, and sleep issues they are experiencing. Rehabilitating and educating patients on these issues helps them improve their outcomes post discharge from the ICU.
2. SLP Communication/Cognition Evaluation and Documentation
It is important for speech pathologists to evaluate patients' expressive, receptive, and cognitive abilities post injury to the brain. Educating patients and families regarding brain injury levels and how to improve mentation outcomes by structuring their environment is key for patient success. Team collaboration and communication to the medical staff helps patients achieve their goals.
3. SLP Swallowing Evaluation and Documentation
A thorough bedside swallowing evaluation is needed for patients with injuries to the brain. Assessing cranial nerves involved in swallowing for both motor and sensation issues helps the speech pathologist conclude route of nutritional intake. The key is to utilize enough trial feedings with all consistencies of food and fluids to determine if safety of oral intake is a critical thinking task for the speech pathologists. Knowing the fluctuations of the patient's medical and cognitive status helps determine if a patient can start all oral feeds or combination of nonoral and oral feeds. Team collaboration is imperative for the patient to achieve safe oral alimentation.
4. Interprofessional Collaboration: Cross Communication
When multiple healthcare professionals work together to achieve patient-centered care, optimal outcomes are achieved. Communication with all team members, especially the RN, before and after patient care is needed due to the medical fragility of these patients. Coevaluations with PT/OT and cotreatments integrate communication and keep the patients’ goals in perspective. With a team approach, the patients can transfer to the next level safely. Team collaboration daily is the key to success.
