Speech Language Pathology in the Neurocritical Care Unit

Purpose of review The aim of this study is to review the scope of practice of speech language pathologists (SLPs) in the daily practice of neurocritical care. Recent findings In patients with aphasia, impairment-based or function-based language interventions improve outcomes. Augmentative and alternative communication devices can help certain patients with severely impaired speech production. After tracheostomy, one-way speaking valves can be placed either in-line with a ventilator or after weaning; it has been shown that earlier placement is associated with faster decannulation. Swallow screening, bedside swallow evaluations, and instrumental swallowing evaluations such as videofluoroscopic swallow studies (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) are valuable tools for diagnosing dysphagia and identifying candidates for percutaneous enteral gastrostomy. Deficit-based rehabilitation of dysphagia is centered on re-training swallowing muscles and reorganizing neural synapses involved in swallowing function, capitalizing on the principles of neuroplasticity and motor learning. Neuromodulation therapies such as pharyngeal electrical stimulation can promote functional reorganization of cortical pathways involved in swallowing and show promise to improve swallow function and reduce aspiration risk. Summary SLPs are essential members of the multi-disciplinary neurocritical care team, particularly with regard to the evaluation and management of communication, cognition, and swallowing dysfunction.